Focal Nodular Hyperplasia-Like Nodules in Alcoholic Liver Cirrhosis: Radiologic-Pathologic Correlation
Young Han Lee1,
Seong Hyun Kim1,2,
Mee-Yon Cho3,
Kwang Yong Shim4 and
Myung Soon Kim1
1 Department of Radiology, Wonju Christian Hospital, Wonju College of Medicine,
Yonsei University, 162 Ilsan-dong, Wonju, Gangwon-do 220-701, South
Korea.
2 Present address: Department of Radiology and Center for Imaging Science,
Samsung Medical Center, Sungkyunkwan University School of Medicine, 50
Ilwon-dong, Gangnam-gu, Seoul 135-710, South Korea.
3 Department of Pathology, Wonju Christian Hospital, Wonju College of Medicine,
Yonsei University, Wonju, Gangwon-do 220-701, South Korea.
4 Department of Oncology, Wonju Christian Hospital, Wonju College of Medicine,
Yonsei University, Wonju, Gangwon-do 220-701, South Korea.
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Fig. 1A —43-year-old man with 1.2-cm-diameter focal nodular hyperplasia
(FNH)-like nodule in right liver (case 1). Contrast-enhanced CT scan obtained
on arterial phase shows hypervascular nodule (arrow) in right liver.
This was followed by faintly hypoattenuated nodule relative to surrounding
cirrhotic liver at delayed phase (not shown) with no characteristic findings
of central scar.
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Fig. 1B —43-year-old man with 1.2-cm-diameter focal nodular hyperplasia
(FNH)-like nodule in right liver (case 1). Superparamagnetic iron oxide
(SPIO)-enhanced T2*-weighted gradient-echo image (TR/TE, 157/9.2;
flip angle, 10°) shows hyperintense nodule (arrow) in surrounding
hypointense liver. There were no characteristic findings of central scar on
unenhanced and contrast-enhanced MR images. This nodule was interpreted as
hepatocellular carcinoma.
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Fig. 1C —43-year-old man with 1.2-cm-diameter focal nodular hyperplasia
(FNH)-like nodule in right liver (case 1). Photomicrograph of resected
specimen shows well-demarcated and complete encapsulation (arrows)
with central stellate, scarlike fibrosis (arrowheads). Hepatocytes
display no atypia. (Masson trichrome, x10)
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Fig. 1D —43-year-old man with 1.2-cm-diameter focal nodular hyperplasia
(FNH)-like nodule in right liver (case 1). Immunohistochemistry image shows
marked increase of Kupffer cells (arrowheads) in FNH-like nodule (N)
compared with surrounding cirrhotic liver (S). Asterisk = fibrous capsule.
(CD68 immunostain, x200)
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Fig. 2A —40-year-old man with hypervascular mass that showed interval
decrease in size during 8 months of followup (case 2). Contrast-enhanced CT
scan obtained on arterial phase shows 4.5-cm-diameter hypervascular mass
(arrow) in right liver. Mass was initially interpreted as
hepatocellular carcinoma, and transcatheter arterial chemoembolization was
performed (not shown).
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Fig. 2B —40-year-old man with hypervascular mass that showed interval
decrease in size during 8 months of followup (case 2). Contrast-enhanced CT
scan obtained at arterial phase 8 months after initial CT examination
(A) and after transcatheter arterial chemoembolization shows interval
decrease in size of mass to 2.5 cm (arrow) and hypervascular
enhancement same as A with no iodized oil within mass in right
liver.
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Fig. 2C —40-year-old man with hypervascular mass that showed interval
decrease in size during 8 months of followup (case 2). Unenhanced
T2*-weighted gradient-echo image (TR/TE, 157/9.2; flip angle,
10°) obtained 8 months after initial CT examination (A) and after
transcatheter arterial chemoembolization shows very hypointense
2.5-cm-diameter nodule with faintly hyperintense area within nodule
(arrow).
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Fig. 2D —40-year-old man with hypervascular mass that showed interval
decrease in size during 8 months of followup (case 2). Superparamagnetic iron
oxide-enhanced T2*-weighted gradient-echo image (157/9.2; flip
angle, 10°) obtained 8 months after initial CT examination (A) and
after transcatheter arterial chemoembolization shows hypointense nodule
(arrow), same as that shown on unenhanced image (C), with no
contrast difference between nodule and surrounding hypointense liver.
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Fig. 2E —40-year-old man with hypervascular mass that showed interval
decrease in size during 8 months of followup (case 2). Photomicrograph of
biopsied specimen obtained 8 months after initial CT examination (A)
and after transcatheter arterial chemoembolization shows thick-walled blood
vessel (arrows) and sinusoidal dilatation (arrowheads).
Hepatocytes in nodule display slight cellular atypia with irregular trabecular
pattern and marked intracellular hemosiderin deposits. (H and E,
x400)
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Fig. 2F —40-year-old man with hypervascular mass that showed interval
decrease in size during 8 months of followup (case 2). Photomicrograph of
biopsied specimen obtained 8 months after initial CT examination (A)
and after transcatheter arterial chemoembolization shows marked iron
deposition in hepatocytes and Kupffer cells (arrowheads) in nodule
compared with surrounding cirrhotic liver. (Prussian blue, x400)
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Fig. 3B —39-year-old man with hypervascular nodule with macrovesicular
steatosis (case 3). Contrast-enhanced CT scan obtained on arterial phase shows
hypervascular nodule (arrow) in right liver.
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Fig. 3C —39-year-old man with hypervascular nodule with macrovesicular
steatosis (case 3). Contrast-enhanced CT scan obtained on delayed phase shows
hypoattenuated nodule (arrow) at same level as B with washout
pattern. Nodule was interpreted as hepatocellular carcinoma.
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Fig. 3D —39-year-old man with hypervascular nodule with macrovesicular
steatosis (case 3). Photomicrograph of biopsied specimen shows macrovesicular
steatosis (arrowheads) in nodule (N) compared with surrounding
cirrhotic liver (S). Asterisk = fibrous capsule. (H and E, x100)
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