Korean J Radiol.  2000 Sep;1(3):165-168. 10.3348/kjr.2000.1.3.165.

Solitary Necrotic Nodules of the Liver Mimicking Hepatic Metastasis: Report of Two Cases

• Yoon KH
• Yun KJ
• Lee JM
• Kim CG

• KMID: 877078
• DOI: http://doi.org/10.3348/kjr.2000.1.3.165

Abstract

We present two cases of solitary necrotic nodules of the liver which on radiologic images mimicked hepatic metastasis. Solitary necrotic nodule of the liver is a rare but benign entity which histopathologically consists of an outer fibrotic cap-sule with inflammatory cells and a central core of amorphous necrotic material. The lesion was seen on contrast-enhanced CT as an ovoid-shaped hypoattenu-ating nodule; on CT during hepatic arteriography as enhancing nodule; on intra-operative US as a target-appearing hypoechoic nodule; on T2WI as a hyperinten-sity nodule, and on dynamic MR as a subtle peripheral enhancing nodule. Although the radiologic features are not specific, solitary necrotic nodule of the liver should be included in the differential diagnosis of hepatic metastasis.

Keyword

Liver, CT; Liver, diseases; Liver, infection

MeSH Terms

Aged
Case Report
Diagnosis, Differential
Female
Human
Liver/*pathology
Liver Diseases/*diagnosis/radiography/ultrasonography
Liver Neoplasms/*secondary
Magnetic Resonance Imaging
Male
Middle Age
Necrosis
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 A 54-year-old woman with gallbladder cancer and solitary necrotic nodule of the liver. A. CTAP shows an ovoid-shaped area of portal perfusion defect (arrows), 1.0 cm in diameter, in the right hepatic lobe. B. CTHA shows a highly enhancing nodular lesion (arrows) in the same area. C. Intraoperative US shows an additional target-appearing hypoechoic nodule (arrows), 0.5 cm in diameter, in the same segment of the liver. D. Photomicrograph shows central amorphous necrosis (arrows) surrounded by a fibrotic capsule, with infiltration by inflammatory cells (arrowheads) (hematoxylin-eosin stain, ×13).

• 

  Fig. 2 A 72-year-old man who six years earlier had undergone subtotal gastrectomy due to gastric cancer. A. Contrast-enhanced CT shows an elliptical hypoattenuating nodule (arrow) in the lateral segment of the liver. B. Contrast-enhanced T1-weighted MR image shows a subtle peripheral enhancing nodule (arrow) at the same site.

Reference

1. Shepherd NA, Lee G. Solitary necrotic nodules of the liver stimulating hepatic metastases. J Clin Pathol. 1983. 36:1181–1183.

2. Alfieri S, Carriero C, Doglietto GB, Pacelli F, Crucitti F. Solitary necrotic nodule of the liver: diagnosis and treatment. Hepatogastroenterology. 1997. 44:1210–1211.

3. Tsui WMS, Yuen RWS, Chow LTC, Tse CCH. Solitary necrotic nodule of the liver: parasitic origin? J Clin Pathol. 1992. 45:975–978.

4. Berry CL. Solitary necrotic nodule of the liver: a probable pathogenesis. J Clin Pathol. 1985. 38:1278–1280.

5. Sundaresan M, Lyons B, Akosa AB. 'Solitary' necrotic nodules of the liver: an etiology reaffirmed. Gut. 1991. 32:1378–1380.

6. Soyer P, Levesque M, Elias D, Zeitoun G, Roche A. Preoperative assessment of resectability of hepatic metastases from colon carcinoma: CT portography vs sonography and dyanamic CT. AJR. 1992. 159:741–744.

7. Hagspiel KD, Neidl KFW, Eichenberger AC, Weder W, Marincek B. Detection of liver metastases: comparison of superparamagnetic iron oxide-enhanced and unenhanced MR imaging at 1.5 T with dynamic CT, intraoperative US, and percutaneous US. Radiology. 1995. 196:471–478.

8. Yoon K-H, Ha HK, Lee JS, et al. Inflammatory pseudotumor of the liver in patients with recurrent pyogenic cholangitis: CT-histopathologic correlation. Radiology. 1999. 211:373–379.

9. Won JH, Kim M-J, Kim BM, et al. Focal eosinophilic infiltration of the liver: a mimick of hepatic metastasis. Abdom Imaging. 1999. 24:369–372.

10. Lee WJ, Lim HK, Lim JH, Kim SH, Choi SH, Lee SJ. Foci of eosinophil-related necrosis in the liver: imaging findings and correlation with eosinophilia. AJR. 1999. 172:1255–1261.