Solitary Necrotic Nodules of the Liver: Cross-Sectional Imaging Findings and Follow-Up in Nine Patients
Stefano Colagrande1,
Maria Lara Paolucci1,
Luca Messerini2,
Wolfgang Schima3,
Alfred Stadler3,
Tommaso Vincenzo Bartolotta4,
Angelo Vanzulli5 and
Giuseppe Brancatelli4,6
1 Department of Clinical Physiopathology, Section of Radiodiagnostics,
University of Florence, Viale Morgagni 85, Azienda Ospedaliero-Universitaria
Careggi, 50134 Florence, Italy.
2 Department of Human Pathology and Oncology, University of Florence, Florence,
Italy.
3 Department of Radiology, Medical University of Vienna, Vienna, Austria.
4 Department of Radiology, University of Palermo, Palermo, Italy.
5 Department of Diagnostic and Interventional Radiology, Niguarda Ca Granda
Hospital, Milan, Italy.
6 Department of Radiology, University of Pittsburgh School of Medicine,
Pittsburgh, PA.
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Fig. 1A —30-year-old woman with subcapsular solitary necrotic nodule
in right lobe of liver (patient 4). Nodule (arrow) in segment VI is
hypoechoic on sonogram (A) and hypoattenuating on unenhanced CT scan
(B).
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Fig. 1B —30-year-old woman with subcapsular solitary necrotic nodule
in right lobe of liver (patient 4). Nodule (arrow) in segment VI is
hypoechoic on sonogram (A) and hypoattenuating on unenhanced CT scan
(B).
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Fig. 1C —30-year-old woman with subcapsular solitary necrotic nodule
in right lobe of liver (patient 4). At 2-year follow-up, nodule
(arrow) is isoechoic and difficult to distinguish from surrounding
parenchyma on sonogram (C). Unenhanced CT scan (D) shows
involution into calcification (arrow).
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Fig. 1D —30-year-old woman with subcapsular solitary necrotic nodule
in right lobe of liver (patient 4). At 2-year follow-up, nodule
(arrow) is isoechoic and difficult to distinguish from surrounding
parenchyma on sonogram (C). Unenhanced CT scan (D) shows
involution into calcification (arrow).
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Fig. 1E —30-year-old woman with subcapsular solitary necrotic nodule
in right lobe of liver (patient 4). At 5-year follow-up, nodule appears
slightly hyperechoic and not well identifiable on sonogram (E);
acoustic shadowing from calcification is seen (arrow). On CT scan
(F), nodule (arrow) appears more calcified and smaller in
comparison with D.
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Fig. 1F —30-year-old woman with subcapsular solitary necrotic nodule
in right lobe of liver (patient 4). At 5-year follow-up, nodule appears
slightly hyperechoic and not well identifiable on sonogram (E);
acoustic shadowing from calcification is seen (arrow). On CT scan
(F), nodule (arrow) appears more calcified and smaller in
comparison with D.
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Fig. 2A —40-year-old man with subcapsular solitary necrotic nodule in
right lobe of liver (patient 5). Unenhanced CT scan shows nearly
isoattenuating lesion (arrow) in segment VI due to moderate fatty
infiltration of surrounding liver.
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Fig. 3A —37-year-old woman with solitary necrotic nodule in right lobe
of liver (patient 6). Unenhanced (A) and contrast-enhanced (B)
CT scans show subcapsular hypoattenuating lesion (arrow). Nodule is
calcified (arrow) on 2-year follow-up CT scan (C).
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Fig. 3B —37-year-old woman with solitary necrotic nodule in right lobe
of liver (patient 6). Unenhanced (A) and contrast-enhanced (B)
CT scans show subcapsular hypoattenuating lesion (arrow). Nodule is
calcified (arrow) on 2-year follow-up CT scan (C).
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Fig. 3C —37-year-old woman with solitary necrotic nodule in right lobe
of liver (patient 6). Unenhanced (A) and contrast-enhanced (B)
CT scans show subcapsular hypoattenuating lesion (arrow). Nodule is
calcified (arrow) on 2-year follow-up CT scan (C).
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Fig. 3D —37-year-old woman with solitary necrotic nodule in right lobe
of liver (patient 6). MRI performed at same time as C shows lesion
(arrow) as hypointense and nearly isointense to surrounding liver
parenchyma on transverse T2-weighted fat-suppressed turbo spin-echo (D)
and T1-weighted gradient-echo (E) images, respectively. T1-weighted
gadolinium-enhanced gradient-echo MR image (F) shows no contrast
enhancement within lesion (arrow).
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Fig. 3E —37-year-old woman with solitary necrotic nodule in right lobe
of liver (patient 6). MRI performed at same time as C shows lesion
(arrow) as hypointense and nearly isointense to surrounding liver
parenchyma on transverse T2-weighted fat-suppressed turbo spin-echo (D)
and T1-weighted gradient-echo (E) images, respectively. T1-weighted
gadolinium-enhanced gradient-echo MR image (F) shows no contrast
enhancement within lesion (arrow).
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Fig. 3F —37-year-old woman with solitary necrotic nodule in right lobe
of liver (patient 6). MRI performed at same time as C shows lesion
(arrow) as hypointense and nearly isointense to surrounding liver
parenchyma on transverse T2-weighted fat-suppressed turbo spin-echo (D)
and T1-weighted gradient-echo (E) images, respectively. T1-weighted
gadolinium-enhanced gradient-echo MR image (F) shows no contrast
enhancement within lesion (arrow).
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Fig. 4A —Histopathologic features of various noncalcified and
calcified solitary necrotic nodules of liver. Photomicrographs from
30-year-old woman with subcapsular solitary necrotic nodule in right lobe of
liver (patient 4). Lesion consists of core of eosinophilic coagulative
necrosis (asterisk) clearly separated from surrounding liver tissue
by rim of collagenous tissue (arrows). (H and E, x100)
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Fig. 4B —Histopathologic features of various noncalcified and
calcified solitary necrotic nodules of liver. Photomicrographs from
30-year-old woman with subcapsular solitary necrotic nodule in right lobe of
liver (patient 4). Lesion consists of core of eosinophilic coagulative
necrosis (asterisk) clearly separated from surrounding liver tissue
by rim of collagenous tissue (arrows). (H and E, x100)
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Fig. 4C —Histopathologic features of various noncalcified and
calcified solitary necrotic nodules of liver. Photomicrograph from 40-year-old
man with subcapsular solitary necrotic nodule in right lobe of liver (patient
5) shows necrotic area containing some inflammatory mononuclear cells
(arrows). (H and E, x200)
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Fig. 4D —Histopathologic features of various noncalcified and
calcified solitary necrotic nodules of liver. Photomicrograph from 37-year-old
woman with solitary necrotic nodule in right lobe of liver (patient 6) shows
large number of mononuclear inflammatory cells (arrows) and some
nuclear debris (circles) in necrotic area. (H and E, x200)
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Fig. 4E —Histopathologic features of various noncalcified and
calcified solitary necrotic nodules of liver. Photomicrograph from 75-year-old
man with subcapsular solitary necrotic nodule (patient 1). Central necrotic
core due to coagulative necrosis shows several calcium depositions
(arrows). Different tone of this photomicrograph in comparison with
A–C is due to different time of tissue fixation. (H and E,
x200)
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