Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-19T14:44:41.454Z Has data issue: false hasContentIssue false

Case 20 - Hepatocellular carcinoma mimicking focal nodular hyperplasia

from Section 2 - Liver

Published online by Cambridge University Press:  05 November 2011

Fergus V. Coakley
Fergus V. Coakley
Affiliation:
University of California, San Francisco
Get access

Summary

Imaging description

At MRI, focal nodular hyperplasia appears as a mass that is mildly hypointense on T1-weighted images, mildly hyperintense on T2-weighted images, hypervascular after gadolinium administration, and has a central scar that is of high T2 signal with delayed enhancement after gadolinium [1–4]. When all these findings are present, the diagnosis of focal nodular hyperplasia can usually be made with high accuracy [2,5]. However, hepatocellular carcinoma arising in a cirrhotic liver can demonstrate all of these features and so a diagnosis of focal nodular hyperplasia in a patient with cirrhosis should be made with great caution (Figures 20.1 and 20.2) [6].

Importance

Hepatocellular carcinoma has a wide spectrum of findings including an appearance indistinguishable from focal nodular hyperplasia. As such, hepatocellular carcinoma should be the primary consideration for any solid lesion in a cirrhotic liver that is not a hemangioma [2]. This approach may result in earlier diagnosis and treatment of hepatocellular carcinoma and prevent inappropriate management resulting from a potentially mistaken diagnosis of focal nodular hyperplasia.

Typical clinical scenario

The possibility of hepatocellular carcinoma mimicking focal nodular hyperplasia arises primarily in patients with cirrhosis, of whatever etiology. The diagnosis of cirrhosis is usually obvious due to the presence of diffuse hepatic nodularity and signs of portal hypertension.

Type
Chapter
Information
Pearls and Pitfalls in Abdominal Imaging
Pseudotumors, Variants and Other Difficult Diagnoses
 , pp. 64 - 67
Publisher: Cambridge University Press
Print publication year: 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Hytiroglou, P, Theise, ND. Differential diagnosis of hepatocellular nodular lesions. Semin Diagn Pathol 1998; 15: 285–299.Google ScholarPubMed
Coakley, FV, Schwartz, LH. Imaging of hepatocellular carcinoma: a practical approach. Semin Oncol 2001; 28: 460–473.CrossRefGoogle ScholarPubMed
Craig, JR, Peters, RL, Edmondson, HA. Tumors of the liver and intrahepatic bile ducts. In: Atlas of tumor pathology (Series 2, Fascicle 26). Washington, DC: Armed Forces Institute of Pathology, 1989.Google Scholar
Jeong, YY, Yim, NY, Kang, HK. Hepatocellular carcinoma in the cirrhotic liver with helical CT and MRI: imaging spectrum and pitfalls of cirrhosis-related nodules. Am J Roentgenol 2005; 185: 1024–1032.CrossRefGoogle ScholarPubMed
Vilgraine, V, Flejou, JF, Arrive, L, et al. Focal nodular hyperplasia of the liver: MR imaging and pathologic correlation in 37 patients. Radiology 1992; 184: 699–703.CrossRefGoogle Scholar
Rafaelian, O, Coakley, FV, Qayyum, A, et al. Magnetic resonance imaging of hepatocellular carcinoma mimicking focal nodular hyperplasia: a potential pitfall in patients with cirrhosis?J Comput Assist Tomogr 2006; 30: 796–799.CrossRefGoogle ScholarPubMed
Sugihara, S, Nakashima, O, Kiyomatsu, K, et al. A case of liver cirrhosis with a hyperplastic nodular lesion. Acta Pathol Jpn 1990; 40: 699–703.Google ScholarPubMed
Terada, T, Kitani, S, Ueda, K, et al. Adenomatous hyperplasia of the liver resembling focal nodular hyperplasia in patients with chronic liver disease. Virchows Arch A Pathol Anat Histopathol 1993; 422: 247–252.CrossRefGoogle ScholarPubMed
Quaglia, A, Tibballs, J, Grasso, A, et al. Focal nodular hyperplasia-like areas in cirrhosis. Histopathology 2003; 42: 14–21.CrossRefGoogle ScholarPubMed
An, HJ, Illei, P, Diflo, T, et al. Scirrhous changes in dysplastic nodules do not indicate high-grade status. J Gastroenterol Hepatol 2003; 18: 660–665.CrossRefGoogle Scholar
Libbrecht, L, Bielen, D, Verslype, C, et al. Focal lesions in cirrhotic explant livers: pathological evaluation and accuracy of pretransplantation imaging examination. Liver Transpl 2002; 8: 749–761.CrossRefGoogle Scholar
Nakashima, O, Kurogi, M, Yamaguchi, R, et al. Unique hypervascular nodules in alcoholic liver cirrhosis: identical to focal nodular hyperplasia-like nodules?J Hepatol 2004; 41: 992–998.CrossRefGoogle ScholarPubMed
Lee, YH, Kim, SH, Cho, MY, Shim, KY, Kim, MS. Focal nodular hyperplasia-like nodules in alcoholic liver cirrhosis: radiologic-pathologic correlation. Am J Roentgenol 2007; 188: W459–W463.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×