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

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.

Small hypervascular hepatocellular carcinomas: value of “washout” on gadolinium-enhanced dynamic MR imaging compared to superparamagnetic iron oxide-enhanced imaging

“…Diagnosis was based on the progression of lesion size or hepatic arteriography and iodised-oil CT findings for such patients. There remains the possibility of borderline malignant lesions, including hypervascular, hyperplastic nodules [32,33], unusually hypervascular dysplastic nodules or well-differentiated HCCs. Due to the relatively small number of tumor vessels and the patency of portal venous perfusion, however, sustaining iodised-oil accumulation has not been reported for such lesions.…”

Imaging of focal nodular hyperplastic-like nodules in alcoholic liver cirrhosis patients using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid magnetic resonance imaging

“…These findings were highly suggestive of a well-differentiated HCC. In most previous reports, these FNH-like nodules arising in patients with alcoholic liver cirrhosis lesions showed that the dynamic CT imaging resembles HCC, and furthermore, these two lesions are very difficult to differentiate from one another [1,[7][8][9][10].…”

Hepatic angiosarcoma with an associated focal nodular hyperplasia-like nodule

“…In the segmentectomy specimens, AS and the FNH-like nodule were located in intimate association, and abnormal blood vessels were also found, even outside the FNH-like nodule. In general, hypervascular hyperplastic nodules including FNHlike nodules are known to occur in alcoholic liver fibrosis, and FNH and FNH-like nodules have been considered to be localized lesions resulting from reactions to an abnormal circulatory change [3,4,6,7,11,12]. In fact, FNH is frequently associated with hepatic hemangioma, a benign counterpart of AS [2,13].…”