Telangiectatic Hyperplastic Nodule Associated with Vascular Malformation in a Patient with Chronic Hepatitis B: Radiologic and Pathologic Features

Gonzalo Carrasco; Cecilia Besa; Sara C. Lewis; Hena S. Kadri; Spiros Hiotis; Swan N. Thung

doi:10.1055/s-0033-1345720

Seminars in Liver Disease, Inhaltsverzeichnis

Semin Liver Dis 2013; 33(02): 178-184
DOI: 10.1055/s-0033-1345720

Diagnostic Problems in Hepatology

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Telangiectatic Hyperplastic Nodule Associated with Vascular Malformation in a Patient with Chronic Hepatitis B: Radiologic and Pathologic Features

Gonzalo Carrasco

¹Division of Liver Pathology, Department of Pathology, The Lillian and Henry Stratton - Hans Popper, Icahn School of Medicine at Mount Sinai, New York, New York

,

Cecilia Besa

²Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York

,

Sara C. Lewis

²Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York

,

Hena S. Kadri

³Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York

,

Spiros Hiotis

³Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York

,

Swan N. Thung

¹Division of Liver Pathology, Department of Pathology, The Lillian and Henry Stratton - Hans Popper, Icahn School of Medicine at Mount Sinai, New York, New York

› Institutsangaben

Abstract

Recognizing hepatocellular nodules that cannot be classified as typical for hepatocellular carcinoma, hepatocellular adenoma, or focal nodular hyperplasia is important, especially in a patient with high risk for hepatocellular carcinoma. The authors report a case of a 53-year-old man with chronic hepatitis B, who was referred to the hospital with a liver mass found on routine imaging follow-up. Abdominal ultrasound revealed a 2.4-cm hypoechoic lesion. Contrast computed tomography showed homogeneous arterial enhancement and mild hyperdensity on portal venous phase images. Due to the high risk for hepatocellular carcinoma, the patient underwent laparoscopic left lateral segmentectomy that revealed a 2.2-cm poorly defined red-brown lesion. The nodule was diagnosed as a hypervascular/telangiectatic hyperplastic hepatocellular nodule based on histopathologic findings and immunostaining profile with negative glutamine synthetase, diffuse positive CD34 highlighting hyperplastic endothelial cells along the telangiectatic sinusoids and dilated vascular channels, and CK7 and CK19 reactive normal bile ducts within the lesion.

Keywords

telangiectatic hyperplastic nodule - liver mass - chronic hepatitis B - benign mass - vascular malformation

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References
1 Bruix J, Sherman M ; American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology 2011; 53 (3) 1020-1022
2 Colli A, Fraquelli M, Casazza G , et al. Accuracy of ultrasonography, spiral CT, magnetic resonance, and alpha-fetoprotein in diagnosing hepatocellular carcinoma: a systematic review. Am J Gastroenterol 2006; 101 (3) 513-523
3 Forner A, Vilana R, Ayuso C , et al. Diagnosis of hepatic nodules 20. mm or smaller in cirrhosis: prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology 2008; 47 (1) 97-104
4 Sangiovanni A, Manini MA, Iavarone M , et al. The diagnostic and economic impact of contrast imaging techniques in the diagnosis of small hepatocellular carcinoma in cirrhosis. Gut 2010; 59 (5) 638-644
5 Khalili K, Kim TK, Jang HJ , et al. Optimization of imaging diagnosis of 1-2 cm hepatocellular carcinoma: an analysis of diagnostic performance and resource utilization. J Hepatol 2011; 54 (4) 723-728
6 Vilgrain V. Focal nodular hyperplasia. Eur J Radiol 2006; 58 (2) 236-245
7 Faria SC, Iyer RB, Rashid A, Whitman GJ. Hepatic adenoma. AJR Am J Roentgenol 2004; 182 (6) 1520
8 Katabathina VS, Menias CO, Shanbhogue AK, Jagirdar J, Paspulati RM, Prasad SR. Genetics and imaging of hepatocellular adenomas: 2011 update. Radiographics 2011; 31 (6) 1529-1543
9 Grazioli L, Bondioni MP, Haradome H , et al. Hepatocellular adenoma and focal nodular hyperplasia: value of gadoxetic acid-enhanced MR imaging in differential diagnosis. Radiology 2012; 262 (2) 520-529
10 Silva AC, Evans JM, McCullough AE, Jatoi MA, Vargas HE, Hara AK. MR imaging of hypervascular liver masses: a review of current techniques. Radiographics 2009; 29 (2) 385-402
11 Vilgrain V, Boulos L, Vullierme MP, Denys A, Terris B, Menu Y. Imaging of atypical hemangiomas of the liver with pathologic correlation. Radiographics 2000; 20 (2) 379-397
12 Leslie DF, Johnson CD, Johnson CM, Ilstrup DM, Harmsen WS. Distinction between cavernous hemangiomas of the liver and hepatic metastases on CT: value of contrast enhancement patterns. AJR Am J Roentgenol 1995; 164 (3) 625-629
13 Burt A, Portman B, Ferrell L. Tumours and tumour-like lesions of the liver. In: MacSween's Pathology of the Liver. 6th ed. Philadelphia, PA: Churchill Livingstone; 2011: 761-851
14 Nguyen BN, Fléjou JF, Terris B, Belghiti J, Degott C. Focal nodular hyperplasia of the liver: a comprehensive pathologic study of 305 lesions and recognition of new histologic forms. Am J Surg Pathol 1999; 23 (12) 1441-1454
15 Paradis V, Benzekri A, Dargère D , et al. Telangiectatic focal nodular hyperplasia: a variant of hepatocellular adenoma. Gastroenterology 2004; 126 (5) 1323-1329
16 Attal P, Vilgrain V, Brancatelli G , et al. Telangiectatic focal nodular hyperplasia: US, CT, and MR imaging findings with histopathologic correlation in 13 cases. Radiology 2003; 228 (2) 465-472
17 Shafizadeh N, Kakar S. Diagnosis of well-differentiated hepatocellular lesions: role of immunohistochemistry and other ancillary techniques. Adv Anat Pathol 2011; 18 (6) 438-445
18 Bioulac-Sage P, Laumonier H, Rullier A , et al. Over-expression of glutamine synthetase in focal nodular hyperplasia: a novel easy diagnostic tool in surgical pathology. Liver Int 2009; 29 (3) 459-465
19 Ahmad I, Iyer A, Marginean CE , et al. Diagnostic use of cytokeratins, CD34, and neuronal cell adhesion molecule staining in focal nodular hyperplasia and hepatic adenoma. Hum Pathol 2009; 40 (5) 726-734
20 Coston WM, Loera S, Lau SK , et al. Distinction of hepatocellular carcinoma from benign hepatic mimickers using Glypican-3 and CD34 immunohistochemistry. Am J Surg Pathol 2008; 32 (3) 433-444
21 Nolte M, Werner M, Nasarek A , et al. Expression of proliferation associated antigens and detection of numerical chromosome aberrations in primary human liver tumours: relevance to tumour characteristics and prognosis. J Clin Pathol 1998; 51 (1) 47-51
22 Wanless IR, Lentz JS, Roberts EA. Partial nodular transformation of liver in an adult with persistent ductus venosus. Review with hypothesis on pathogenesis. Arch Pathol Lab Med 1985; 109 (5) 427-432
23 Shimamatsu K, Wanless IR. Role of ischemia in causing apoptosis, atrophy, and nodular hyperplasia in human liver. Hepatology 1997; 26 (2) 343-350
24 Tanaka M, Wanless IR. Pathology of the liver in Budd-Chiari syndrome: portal vein thrombosis and the histogenesis of veno-centric cirrhosis, veno-portal cirrhosis, and large regenerative nodules. Hepatology 1998; 27 (2) 488-496