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Biliary adenofibroma with ominous features of imminent malignant changes

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Abstract

Biliary adenofibroma (BAF) is a rare, benign liver tumor. Herein, we report a case of BAF with histological features of imminent malignant changes. Ultrasound and CT revealed a solid 2.5-cm mass in the right liver lobe. The patient was asymptomatic and had no past medical history including liver disease. A general examination that included the abdomen and the laboratory data were normal. Because of the increase of its size, this tumor was surgically resected. Grossly, a 3.5-cm nodular mass abutted on the hepatic capsule was found, and its cut surface showed a well-circumscribed, whitish, and firm lesion that showed microcystic changes in the periphery and solid changes in the central parts. Histologically, the tumor showed a proliferation of tubulocystic structures embedded in a fibrous stroma. Microcysts were prevalent in the periphery, while tubular components with abundant fibrous stroma were in the central parts. The tubules were variably dilated and branched. This case closely resembled the previously reported cases of BAF, except that there were complicated papillary projections with fine fibrovascular cores in some of the microcysts and that the epithelial component in papillary projections showed dysplastic changes and increased cellular proliferative activities, implicating ominous features of imminent malignant changes. These dysplastic and papillary changes may be an intermediate lesion leading to malignancy, which have occasionally been reported in BAF.

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Acknowledgments

We are grateful to Prof. Wilson Tsui, Hong Kong, for comments on this case.

Disclosures

Conflict of Interest: Akemi Tsutsui, Yoshimi Bando, Yasunori Sato, Hidenori Miyake, Seiko Sawada-Kitamura, Hiroshi Shibata, Yuko Kakuda, Kenichi Harada, Motoko Sasaki, and Yasuni Nakanuma declare that they have no conflict of interest.

Human/Animal Rights: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5).

Informed Consent: Informed consent was obtained from all patients for inclusion in the study.

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Authors and Affiliations

  1. Section of Diagnostic Pathology, Department of Pathology, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan

    Akemi Tsutsui & Seiko Sawada-Kitamura

  2. Department of Pathology, Tokushima University Hospital, Tokushima, Japan

    Yoshimi Bando

  3. Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan

    Yasunori Sato, Yuko Kakuda, Kenichi Harada, Motoko Sasaki & Yasuni Nakanuma

  4. Department of Surgery, Tokushima Municipal Hospital, Tokushima, Japan

    Hidenori Miyake

  5. Department of Gastroenterology, Tokushima Prefectural Central Hospital, Tokushima, Japan

    Hiroshi Shibata

  6. Department of Pathology, Shizuoka Cancer Center, Shizuoka, Japan

    Yasuni Nakanuma

Authors
  1. Akemi Tsutsui
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  2. Yoshimi Bando
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  3. Yasunori Sato
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  4. Hidenori Miyake
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  5. Seiko Sawada-Kitamura
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  6. Hiroshi Shibata
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  7. Yuko Kakuda
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  8. Kenichi Harada
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  9. Motoko Sasaki
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  10. Yasuni Nakanuma
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Corresponding author

Correspondence to Akemi Tsutsui.

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Tsutsui, A., Bando, Y., Sato, Y. et al. Biliary adenofibroma with ominous features of imminent malignant changes. Clin J Gastroenterol 7, 441–448 (2014). https://doi.org/10.1007/s12328-014-0523-1

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  • DOI: https://doi.org/10.1007/s12328-014-0523-1

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