CLINICAL CHALLENGES AND IMAGES IN GI Clinical Chameleon: To Be or Not To Be Metastasis Austin Bourgeois,1 Yong Bradley,1 and Laurentia Nodit2 1

Department of Radiology, 2Department of Pathology, University of Tennessee Medical Center, Knoxville, Tennessee

Question: A 65-yearold woman with a prior history of renal cell carcinoma, status post left nephrectomy, presented with vague right upper quadrant abdominal pain. Physical examination revealed no jaundice and a negative Murphy sign. Alanine and aspartate aminotransferases were elevated at 102 and 124 U/ L, respectively, prompting subsequent imaging. Right upper quadrant ultrasonography demonstrated multiple hepatic masses with peripheral hypoechoic halo (Figure A). Computed tomography (CT) and magnetic resonance imaging (MRI; Figure B) showed innumerable hepatic masses with central T2 hyperintensity and incomplete peripheral enhancement on arterial and portal venous phase imaging. There was no evidence of extrahepatic disease. CT-guided biopsy of one of these lesions showed replacement of liver parenchyma by a proliferation of large cells with intracytoplasmic lumina, some containing red blood cells (Figure C, high-magnification photomicrograph; stain, hematoxylin and eosin), which were strongly reactive for CD31 immunostain (Figure D, high-magnification photomicrograph). Immunostains for renal cell carcinoma were nonreactive. The patient complained of mild right upper quadrant pain and was otherwise unremarkable. What is the diagnosis? Look on page 978 for the answer and see the Gastroenterology web site ( for more information on submitting your favorite image to Clinical Challenges and Images in GI. Conflicts of interest The authors disclose no conflicts. © 2014 by the AGA Institute 0016-5085/$36.00

Gastroenterology 2014;147:977–978

CLINICAL CHALLENGES AND IMAGES IN GI Answer to the Clinical Challenges and Images in GI Question: Image 3 (page 977): Hepatic Epithelioid Hemangioendothelioma Epithelioid hemangioendothelioma (EHE) is a rare neoplasm of vascular origin described in 1982,1 which can present in the liver as well as soft tissues, bone, and brain, arising from a medium sized or large vein. It has low incidence in the general population

Clinical chameleon: to be or not to be metastasis.

Clinical chameleon: to be or not to be metastasis. - PDF Download Free
447KB Sizes 0 Downloads 17 Views