Hepatic solitary fibrous tumour

Case contributed by Dr Matt A. Morgan

Presentation

Mass noted on abdominal ultrasound for right upper quadrant pain.

Patient Data

Age: 50-60Y
Gender: Male
MRI

There is a single 4.5 cm mass in the right hepatic lobe:

  • heterogeneous T2 signal intensity
  • uniform T1 hypointensity
  • no evidence of intracellular lipid on the IP/OP sequence (mild diffuse hepatic hypointensity on the IP sequence is artifactual)
  • the mass demonstrates restricted diffusion

There is no evidence of cirrhosis or other diffuse hepatic disease. No other abnormality in the abdomen.

MRI

Postcontrast dynamic sequence [Magnevist 20 ml]

On the postcontrast dynamic sequence, there is heterogeneous enhancement of the mass on the arterial phase, with progressive persistent enhancement on the later phases.

No abnormal enhancement elsewhere in the liver. Hepatic vessels are patent. 

Case Discussion

This is a case of a rare hepatic mesenchymal tumor called a solitary fibrous tumor.

The imaging features are not specific and a prospective diagnosis is not realistic. The point of this case is really the diagnostic reasoning to generate a reasonable differential for the mass.

On the precontrast images, a number of masses, benign and malignant are possible. One should always remember that, although less common, HCC can occur in a liver not affected by cirrhosis (although usually in this situation, there is an occult history of chronic hepatitis B infection) 2.

The postcontrast dynamic sequence, however, has a more benign enhancement pattern. Given the well-circumscribed heterogenously solid appearance of the mass, more rare fibrous tumours could be entertained on the differential

Given the rarity of these lesions, however, a biopsy is still necessary for a diagnosis. An atypical presentation of a common malignant lesion is still more typical than these rare lesions.

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Case information

rID: 34290
Case created: 13th Feb 2015
Last edited: 8th Jan 2016
Inclusion in quiz mode: Included

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