Clinics and Research in Hepatology and Gastroenterology (2015) 39, 280—281
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IMAGE OF THE MONTH
Liver metastases within focal nodular hyperplasias N. Alberti a,∗, C. Castain b, N. Frulio a, A. Crombe a, H. Trillaud a a
Department of Radiology, Hôpital St André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France b Department of Pathology, Hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, Bordeaux, France Available online 22 August 2014
A 57-year-old woman was initially treated in 2007 for an adenoid cystic parotid carcinoma. This tumor was treated by surgery and was controlled for 5 years. The patient presented two focal nodular hyperplasias (FNHs), 80 and 55 mm diameter, developed respectively in the left hepatic lobe and in segment IV fortuitously found 10 years ago. In 2012, CT scans revealed the occurrence of both splenic metastases and a change in the two known FNHs with appearance of centimetric hypodense nodules within the FNHs. Figs. 1, 2 and 3, represent the largest FNH developed in left hepatic lobe, on both MRI and macroscopic analysis. On MRI, the small centimetric nodules within FNHs presented a ‘‘fluidlike signal’’ on both T1 and T2-weighted sequences (Fig. 1) with progressive enhancement after injection of chelates of Gadolinium (Fig. 2). No other lesion was observed in the remaining parenchyma of the liver. The decision to perform a left hepatectomy associated with a splenectomy was taken by a multidisciplinary team. On pathology, the two FNHs contained several cystic lesions, which corresponded
∗ Corresponding author. Tel.: +33 05 56 795800; fax: +33 05 56 795899. E-mail address: [email protected] (N. Alberti).
http://dx.doi.org/10.1016/j.clinre.2014.06.010 2210-7401/© 2014 Elsevier Masson SAS. All rights reserved.
Figure 1 MRI, T2 single shot fat spin echo sequence. Centimetric ‘‘fluid-like signal’’ nodules (arrows) localized in left hepatic lobe (circle).
to metastases from the adenoid cystic parotid carcinoma (Fig. 3, same FNH). Very few cases of metastases superimposed to FNH have been described in the literature [1—3]. In our patient, all the metastases were observed only in the two FHNs, and not in
Liver metastases within focal nodular hyperplasias
281 the remaining liver parenchyma. The arterial hyperaemia of FNH induced an exclusive malignant cells insemination within the FNH lesions in the liver, which could be assimilated to a ‘‘sump effect’’ according to some authors [1]. To conclude, patients with known hypervascular benign lesions warrant careful follow-up, due to the possibility of metastases superimposed on the benign hypervascular lesions such as FNH.
Disclosure of interest The authors declare that they have no conflicts of interest concerning this article. Figure 2 MRI, T1 after gadolinium administration (delayed phase: 5 mn) and fat suppression. Progressive enhancement of the nodules within the same FNH (circle).
Figure 3 Pathology, gross section (fixed specimen). Multiple localisations of an adenoid cystic carcinoma (asterisks) within the same FNH (circle).
References [1] Golfieri R, Cappelli A, La Rosa M, Silvagni E, Camaggi V, Bolondi L. Unusual presentation of melanoma liver metastases superimposed to multiple focal nodular hyperplasia nodules. Euro Rad 2006;10:1594. [2] Nisar PJ, Zaitoun AM, Damera A, Hodi Z, Tierney GM, Beckingham IJ. Metastatic rectal adenocarcinoma to the liver associated with focal nodular hyperplasia. J Clin Pathol 2002;55:967—9. [3] Hagay ZJ, Zirkin HJ, Moses M, Khodadadi J. Ewing’s sarcoma metastatic to focal nodular hyperplasia of liver. J Surg Oncol 1986;32:100—5.
Available online at
ScienceDirect www.sciencedirect.com
IMAGE OF THE MONTH
Liver metastases within focal nodular hyperplasias N. Alberti a,∗, C. Castain b, N. Frulio a, A. Crombe a, H. Trillaud a a
Department of Radiology, Hôpital St André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France b Department of Pathology, Hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, Bordeaux, France Available online 22 August 2014
A 57-year-old woman was initially treated in 2007 for an adenoid cystic parotid carcinoma. This tumor was treated by surgery and was controlled for 5 years. The patient presented two focal nodular hyperplasias (FNHs), 80 and 55 mm diameter, developed respectively in the left hepatic lobe and in segment IV fortuitously found 10 years ago. In 2012, CT scans revealed the occurrence of both splenic metastases and a change in the two known FNHs with appearance of centimetric hypodense nodules within the FNHs. Figs. 1, 2 and 3, represent the largest FNH developed in left hepatic lobe, on both MRI and macroscopic analysis. On MRI, the small centimetric nodules within FNHs presented a ‘‘fluidlike signal’’ on both T1 and T2-weighted sequences (Fig. 1) with progressive enhancement after injection of chelates of Gadolinium (Fig. 2). No other lesion was observed in the remaining parenchyma of the liver. The decision to perform a left hepatectomy associated with a splenectomy was taken by a multidisciplinary team. On pathology, the two FNHs contained several cystic lesions, which corresponded
∗ Corresponding author. Tel.: +33 05 56 795800; fax: +33 05 56 795899. E-mail address: [email protected] (N. Alberti).
http://dx.doi.org/10.1016/j.clinre.2014.06.010 2210-7401/© 2014 Elsevier Masson SAS. All rights reserved.
Figure 1 MRI, T2 single shot fat spin echo sequence. Centimetric ‘‘fluid-like signal’’ nodules (arrows) localized in left hepatic lobe (circle).
to metastases from the adenoid cystic parotid carcinoma (Fig. 3, same FNH). Very few cases of metastases superimposed to FNH have been described in the literature [1—3]. In our patient, all the metastases were observed only in the two FHNs, and not in
Liver metastases within focal nodular hyperplasias
281 the remaining liver parenchyma. The arterial hyperaemia of FNH induced an exclusive malignant cells insemination within the FNH lesions in the liver, which could be assimilated to a ‘‘sump effect’’ according to some authors [1]. To conclude, patients with known hypervascular benign lesions warrant careful follow-up, due to the possibility of metastases superimposed on the benign hypervascular lesions such as FNH.
Disclosure of interest The authors declare that they have no conflicts of interest concerning this article. Figure 2 MRI, T1 after gadolinium administration (delayed phase: 5 mn) and fat suppression. Progressive enhancement of the nodules within the same FNH (circle).
Figure 3 Pathology, gross section (fixed specimen). Multiple localisations of an adenoid cystic carcinoma (asterisks) within the same FNH (circle).
References [1] Golfieri R, Cappelli A, La Rosa M, Silvagni E, Camaggi V, Bolondi L. Unusual presentation of melanoma liver metastases superimposed to multiple focal nodular hyperplasia nodules. Euro Rad 2006;10:1594. [2] Nisar PJ, Zaitoun AM, Damera A, Hodi Z, Tierney GM, Beckingham IJ. Metastatic rectal adenocarcinoma to the liver associated with focal nodular hyperplasia. J Clin Pathol 2002;55:967—9. [3] Hagay ZJ, Zirkin HJ, Moses M, Khodadadi J. Ewing’s sarcoma metastatic to focal nodular hyperplasia of liver. J Surg Oncol 1986;32:100—5.
