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

Byoung Joo Do; In Young Park; So Yon Rhee; Jin Kyung Song; Myoung Kuk Jang; Seong Jin Cho; Eun Sook Nam; Eun Joo Yun

doi:10.4166/kjg.2015.65.5.321

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Do, Park, Rhee, Song, Jang, Cho, Nam, and Yun: A Case of Multiple Hypervascular Hyperplastic Liver Nodules in a Patient with No History of Alcohol Abuse or Chronic Liver Diseases

Case Report

Korean J Gastroenterol 2015;65(5):321-325.

Published online: 4 October 2015

DOI: https://doi.org/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

Byoung Joo Do, In Young Park, So Yon Rhee, Jin Kyung Song, Myoung Kuk Jang, Seong Jin Cho¹, Eun Sook Nam¹, Eun Joo Yun²

Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea

¹Department of Pathology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea

²Department of Radiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea

Correspondence to: Eun Joo Yun, Department of Radiology, Hallym University Kangdong Sacred Heart Hospital, 150 Seongan-ro, Gangdong-gu, Seoul 134-701, Korea. Tel: +82-2-2224-2445, Fax: +82-2-2224-2647, E-mail: yeunjookr@hallym.or.kr

Received 3 August 201416 October 2014 Accepted 17 October 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Liver, Nodule, Hyperplasia, Hypervascular

References

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Fig. 1.

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

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).

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.

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).

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