A CASE OF HEPATOCELLULAR CARCINOMA FOLLOWING THE OPERATION FOR SOLITARY TUBERCULOMA

Solitary tuberculoma of the liver is uncommon and this paper presents a hepatocellular carcinoma (HCC) case which occurred after the operation and antituberculous therapy for solitary tuberculoma of the liver. A 65-year-old man was admitted because of right hypochondralgia. Abdominal contrast computed tomography (CT) showed a mildy enhanced mass in the anterior inferior segment of the liver (S 5). Partial hepatectomy was performed with a suspected diagnosis of hepatoma. Pathohistologically the resected specimen was compatible with tuberculoma containing caseous necrosis and Langhans' giant cells. Antituberculosis drugs were prescribed for one year. Eighteen months after the operation, the enhanced tumor growing segmentally in the right posterior segment of the liver (S 7) was detected by the contrast CT scan. Angiography showed a hypervascularity in this tumor. These findings suggested HCC rather than a recurrence of the solitary tuberculoma, S 7 subsegmentectomy was performed. Microscopic examination revealed a travecular type HCC. A histogenetic relationship between tuberculosis of the liver and HCC was unknow. Abdominal contrast CT and angiography were useful for the definitive diagnosis. However, it is considered that a percutaneous liver needle biopsy should be tried for differential diagnosis of other hepatic tumors.