Yonsei Med J.  2006 Dec;47(6):881-886. 10.3349/ymj.2006.47.6.881.

A Case of Hypervascular Hyperplastic Nodules in a Patient with Alcoholic Liver Cirrhosis

• Moon JH
• Ahn CM
• Chung HS
• Ahn SH
• Park YN

• KMID: 1777181
• DOI: http://doi.org/10.3349/ymj.2006.47.6.881

Abstract

Most hypervascular nodules in a cirrhotic liver are hepatocellular carcinomas (HCCs); however, some are benign hypervascular hyperplastic nodules. We report a case of benign hypervascular hyperplastic nodules in a 41-year-old male patient without hepatitis B or C virus infection, with a history of alcohol abuse, and diagnosed with an aortic aneurysm. The dynamic computerized tomography of the liver demonstrated multiple nodular lesions on both liver lobes with arterial enhancement and delayed washout. The hepatic angiography showed multiple faint nodular staining of both lobes in the early arterial phase. Magnetic resonance imaging revealed numerous nodules showing high signals on T1 weighted images, with some nodules showing a low central signal portion. The clinical impression was HCC. The ultrasonography-guided liver biopsy, which was performed on the largest nodule (2.5 cm in size), revealed hepatocellular nodules with slightly increased cellularity, unpaired arteries, increased sinusoidal capillarization, and focal iron deposition. However, both cellular and cytological atypia were unremarkable. Although the clinical impression was HCC, the pathological diagnosis was hypervascular hyperplastic nodules in alcoholic cirrhosis. Differential diagnosis of hypervascular nodules in cirrhosis and HCC is difficult with imaging studies; thus, histological confirmation is mandatory.

Keyword

Hypervascular hyperplastic nodule; alcoholic liver cirrhosis; hepatocellular carcinoma

MeSH Terms

Tomography, X-Ray Computed
Male
Liver Neoplasms/diagnosis
Liver Cirrhosis, Alcoholic/*complications
Liver/*pathology/radiography/ultrastructure
Hyperplasia
Humans
Diagnosis, Differential
Carcinoma, Hepatocellular/diagnosis
Biopsy
Adult

Figure

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  Fig. 1 Multiple nodular lesions (arrows) with arterial enhancement and delayed washout on both lobes of the liver on the dynamic CT (A: arterial phase, B: portal phase, C: delayed phase, *The lesion was also detected on ultrasonography).

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  Fig. 2 A round hyperechoic lesion with a peripheral halo (arrow) was detected on ultrasonography.

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  Fig. 3 Liver biopsy of the hypervascular hyperplastic nodule. The nodule shows slightly increased cellularity without cellular and structural atypia (A), unpaired arteries (arrow) (B), sinusoidal expression of CD34 (C) and focal iron deposition (D) (A; Hematoxylin-Eosin, × 100, B; Hematoxycin-Eosin, × 200, C; Labeled with Streptavidin Biotin, × 200, D; Prussian blue, × 200).

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  Fig. 4 Numerous nodules with a high signal on T1 weighted images, with a central low signal portion in some nodules (arrows), on the MRI. *The lesion was also detected on ultrasonography.

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  Fig. 5 Arterial phase enhancing nodules suggesting overt HCCs on the MRI (A: arterial phase, B: portal phase, C: delayed phase).

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  Fig. 6 Faint multiple nodular staining of both lobes of the liver in the early arterial phase on angiography.

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