Presentation
Incidental finding of an undefined liver lesion on routine ultrasound.
Patient Data
Longitudinal and transverse oblique ultrasound of the liver shows a hyperechoic homogenous solid rounded mass in the right lobe.
Non contrast CT:
a single rounded predominantly low-density mass with fat tissue attenuation in VI liver segment.
some punctiform bilobar hepatic cysts.
Contrast CT:
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the VI segment lesion shows heterogeneous enhancement with the persistence of hypodense areas
MR without and with Gd-Eob-DTPA depicts:
a VI segment liver mass with signal drop on the OOP images compared to the IP images and hyperintensity on T2, which decreases with fat suppression; these features are consistent with fatty tissue
T1 C+ shows heterogeneous enhancement of the vascular component of the lesion and hypointensity on the Hepatobiliary phase, reflecting the absence of normal hepatocytes
small bilobar T2-hyperintense hepatic cyst
US-guided liver biopsy pathology report (italian):
[...] Frustules of liver tissue lacking portal spaces with altered structure, where dysmetric adipocytes of variable size are found alternating with spindle cells without cytological atypia. Immunomorphological findings are suggestive of angiomyolipoma [...] .
Case Discussion
This is a biopsy-confirmed angiomyolipoma in a young patient with a non-cirrhotic liver.
The finding of a fat-containing liver lesion places a broad spectrum of benign diseases and even hepatocarcinoma in differential diagnosis.
Acknowledgements:
Baletti A, MD; Di Paola C, MD. Sanremo Radiology department, ASL1, Liguria, Italy