Hepatic adenomatosis

Case contributed by Dr. Jason Murri

Presentation

Hepatomegaly and abnormal liver function tests; no B symptoms or adenopathy on exam. No family history of cancer.

Patient Data

Age: 35
Gender: Female
CT

Multiple irregular masses within the liver which demonstrate heterogeneous enhancement on arterial and portal venous phase imaging and are isodense to the liver parenchyma on precontrast and delayed phase imaging. There is breath motion artifact due to patient noncompliance with breath holding techniques.

Pathology Report

FINAL DIAGNOSIS: 

NODULE, LIVER, ULTRASOUND-GUIDED CORE BIOPSY: 
1. LIVER CELL ADENOMA (SEE COMMENT). 
2. NO EVIDENCE OF METASTATIC CARCINOMA. 

COMMENT: The morphologic and immunohistochemical findings are most consistent with liver cell adenoma. If multiple, the diagnosis "liver cell adenomatosis" has been used. 

CLINICAL HISTORY: Multiple liver nodules; long history of oral contraceptive use
PREOPERATIVE DIAGNOSIS: Same
POSTOPERATIVE DIAGNOSIS: Same
SPECIMEN(S): Liver mass

GROSS DESCRIPTION: 
Received in formalin labeled with the patient's name and "liver biopsy"  and consists of five red-tan, needle-core fragments ranging from 0.2 x 0.1 x 0.1 cm to the largest of 2.0 cm in length with a diameter of 0.1 cm. The specimen is submitted entirely within two mesh cassettes. Due to the minute size of the smallest fragment, it may not survive processing. 

MICROSCOPIC DESCRIPTION: 
A microscopic examination has been performed and the findings incorporated into the diagnosis.  Immunohistochemical/special stain(s) is/are performed on block(s) A1 and A2. 

Medical necessity for performing stain(s): To enable diagnosis 

The stain(s) is/are evaluated following validation of appropriate control reactivity, with the following result(s): 

STAIN/RESULT 

 Reticulin Highlights hepatic architecture consistent with adenoma
 CD31  Highlights vascularity
 CD34  "Complete" staining pattern
 Beta catenin Uniform membranous staining 

Case Discussion

Prior contrast enhanced CT scan from about 10 years before showed an unremarkable appearance of the liver. Ultrasound guided liver biopsy was performed for the right inferior lobe lesion with pathology report included above.

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Case information

rID: 58191
Published: 8th Feb 2018
Last edited: 12th Feb 2018
Inclusion in quiz mode: Included
Institution: Franciscan St James Radiology

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