Solitary necrotic nodule of the liver misinterpreted as malignant lesion: Considerations on two cases

Abstract

In our experience, we document 2 cases of a rare and non-tumoral lesion of the liver misinterpreted as necrotic tumor: necrotic solitary nodule. In the first clinical case, ultrasound (US) showed a polylobated lesion (35 × 35 × 38 mm) at segment 8. Color-doppler identified a compression of celiac axis (Dunbar syndrome). Arteriography revealed a subtotal stenosis of celiac tripod soon after the emergence of the left gastric artery. FNAB-CT showed a highly cellulated tissue with a necrotic core surrounded by a fibersclerotic tissue. The patient underwent surgery: cholecystectomy and correction of Dunbar syndrome. US follow-up showed a progressive reduction in diameter of the lesion (24 × 25 × 25 mm at 24 months), suggesting in this case the role of ischemic injury in the pathogenesis of the lesion.In the second clinical case, a hypoechoic lesion (32 × 32 × 30 mm) of segment 6 as occasional US finding during the staging for prostate cancer was shown. FNAC-CT showed a positive result for necrotic cells. Surgical treatment consisted in a wide excision of the lesion. Histologically the lesion was solitary necrotic nodule.The diagnosis of this rare lesion is accidental. In accordance with the literature (50% of cases), we founded an associated tumor. Radiology doesn't differentiate solitary necrotic nodule and other solid lesions. Diagnosis is histological (in our second case, FNAC-CT misinterpreted the tumor as a malignant lesion, while histology showed the real nature of it).

Dynamic assessment of antiangiogenic therapy by monitoring both tumoral vascularization and tissue degeneration

“…De Luca et al 44 reported cases of necrotic nodules misdiagnosed as tumors with ultrasound. They emphasized that there was no correlation between US findings and histology.…”

Solitary necrotic nodule of the liver: a report of two cases and review of the literature

“…PAS, Grocott and acid-fast staining all showed no bacterial, fungal, and parasitic infections [1][2][3][4]. In current study, the cases both had the typical image of SNN, PAS, and acid-fast staining was also negative.…”

“…The majority of patients were single nodule, and the minority were nodules. Average diameter was about 2 ∼ 3 cm; Serum CA-19, CEA and other tumor marker test results were normal [2][3][4]. In our cohorts of patients, one was in the left lobe of the liver parenchyma, the other one was in the right lobe under the liver capsule, and the nodule diameter was 1.8 cm and 4.0 cm, respectively.…”

“…The cause of SNN is uncertain and maybe diverse: SNN might be potentially representing the evolutionary process from various benign diseases, such as infectious abscess, parasitic granuloma, hemangioma (or blood-borne disease), benign tumor, hematoma, trauma, and other benign disease development; about 50% of cases could be found with other types of tumors [1][2][3][4][5][6]. Immunohistochemistry and histochemistry staining of our 2 cases showed intact reticular fibers.…”

“…Literatures reported that most patients' ultrasound showed hypoechoic lesions, or accompanying a slight edge of high echo, and all patients were nonhomogeneous echo [2,4,7]; CT scan of SNN was the low-density lesions, in which a few of cases delayed imaging showed slight edge enhancement [7]. SNN is a rare disease which has not obvious symptoms and potential complications, in the meanwhile, it is not obvious influence on the health [2]; clinicians should give right diagnosis through clinical features combining imaging examination and experimental inspection results.…”