Korean J Gastroenterol.  2015 May;65(5):321-325. 10.4166/kjg.2015.65.5.321.

A Case of Multiple Hypervascular Hyperplastic Liver Nodules in a Patient with No History of Alcohol Abuse or Chronic Liver Diseases

• Do BJ
• Park IY
• Rhee SY
• Song JK
• Jang MK
• Cho SJ
• Nam ES
• Yun EJ

• KMID: 2373230
• DOI: http://doi.org/10.4166/kjg.2015.65.5.321

Abstract

Up-to-date imaging modalities such as three-dimensional dynamic contrast-enhanced CT (3D CT) and MRI may contribute to detection of hypervascular nodules in the liver. Nevertheless, distinguishing a malignancy such as hepatocellular carcinoma from benign hypervascular hyperplastic nodules (HHN) based on the radiological findings is sometimes difficult. Multiple incidental liver masses were detected via abdominal ultrasonography (US) in a 65-year-old male patient. He had no history of alcohol intake and no remarkable past medical history or relevant family history, and his physical examination results and laboratory findings were normal. 3D CT and MRI showed numerous enhanced nodules with hypervascularity during the arterial phase. After US guided liver biopsy, the pathological diagnosis was HHN. To date, several cases of HHN have been reported in patients with chronic alcoholic liver disease or cirrhosis. Herein, we report on a case of HHN in a patient with no history of alcoholic liver disease or cirrhosis.

Keyword

Liver; Nodule; Hyperplasia; Hypervascular

MeSH Terms

Abdomen/diagnostic imaging
Aged
Alcoholism/pathology
Chronic Disease
Diagnosis, Differential
Focal Nodular Hyperplasia/*diagnosis
Humans
Imaging, Three-Dimensional
Liver/diagnostic imaging/*pathology
Liver Diseases/pathology
Magnetic Resonance Imaging
Male
Tomography, X-Ray Computed
Ultrasonography

Figure

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  Fig. 1. Abdominal ultrasonography. Multiple-numerous hypoechoic nodules are seen in both lobes of the liver (arrows).

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  Fig. 2. Abdominal three-dimensional dynamic contrast-enhanced CT images. (A) Pre-enhancement. Multiple nodules are highly enhanced in the arterial phase (B), with decreased enhancement in the portal phase (C), followed by iso-attenuation in the delayed phase (D).

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  Fig. 3. Abdominal MRI. The hepatic nodules show iso-signal intensity on T1-weighted image (A) and T2-weighted image (B). The gadoxetate acid enhanced MR images obtained during the arterial (C) and portal phases (D) show the same findings shown on CT.

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  Fig. 4. Histopathology. (A) The non-nodular portion shows a normal parenchymal structure except for the mild fatty change (H&E stain, ×100).(B) The non-nodular portion shows little immunoreactivity for CD34 (CD34 stain, ×100). (C) The nodules have slightly increased cellularity without cellular atypia and mitotic figures, showing sinusoidal dilatation (arrow) with mild congestion (H&E stain, ×100). (D) The nodules show abundant sinusoidal capillarization and sinusoidal expression of CD34 (arrowhead) (CD34 stain, ×100).

Reference

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