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Asmundo L, Giaccardi L, Soro A, Lanocita R, Buonomenna C, Vigorito R, Leoncini G, Mazzaferro V, Vaiani M. Solitary necrotic nodule of the liver: imaging features, differential diagnosis and management. Eur J Radiol 2025; 183:111869. [PMID: 39647273 DOI: 10.1016/j.ejrad.2024.111869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 11/08/2024] [Accepted: 12/01/2024] [Indexed: 12/10/2024]
Abstract
Solitary necrotic nodule of the liver (SNNL) is a rare and benign liver lesion often discovered incidentally. Despite its occurrence, the exact cause of SNNL remains unknown, with various theories proposing traumatic, infectious, degenerative or transformative origins. The variable imaging characteristics of SNNLs frequently lead to misdiagnosis as malignant tumors, prompting patients to undergo unnecessary and high-risk procedures such as biopsies and surgeries. Moreover, biopsies often yield inconclusive results due to the presence of necrotic tissue within the lesion, posing challenges for accurate histologic diagnosis. This review aims to offer guidance on differentiating SNNLs from other liver lesions using multimodality imaging approaches. It will analyze essential imaging steps that should be performed and highlight those that should be avoided to enhance diagnostic accuracy and prevent unnecessary interventions.
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Affiliation(s)
- Luigi Asmundo
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 02114 Boston, MA, USA
| | - Luca Giaccardi
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Alberto Soro
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Rodolfo Lanocita
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Ciriaco Buonomenna
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Raffaella Vigorito
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Giuseppe Leoncini
- First Pathology Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Vincenzo Mazzaferro
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Marta Vaiani
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy.
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Francica G, Meloni MF, Riccardi L, de Sio I, Caturelli E, Terracciano F, Giangregorio F, Chiang J, Danzi R, Marra A, Niosi M, Ranalli TV, Pompili M. Contrast-Enhanced Ultrasound Findings in Patients with Rare Solitary Necrotic Nodule of the Liver - a Multicenter Report. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:81-88. [PMID: 34433216 DOI: 10.1055/a-1579-9457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE This multicenter retrospective study highlights the contrast-enhanced ultrasound (CEUS) findings in a series of histologically proven solitary necrotic nodules (SNN) of the liver, a poorly understood pathologic entity of uncertain origin that mimics malignancy. MATERIALS AND METHODS 22 patients (M/F 13/9; mean age 59.4 years, SD ± 10.7, range 35-81) with histological diagnosis of SNN and CEUS were selected from clinical, imaging, and pathological archives of 7 US interventional centers, each of which provided 1 to 6 cases (mean 2.8). Pathological diagnosis was made on 20 US-guided biopsies and 2 surgical specimens. 2 patients had 2 SNNs with identical CEUS findings so that imaging analysis was carried out on 24 nodules. RESULTS SNN was an incidental finding in healthy people in 10 cases (45.5 %), and it was discovered during follow-up for either known extrahepatic malignancies (9 cases = 41 %) or chronic liver disease (3 cases = 13.5 %). SNNs had a mean size of 19.3 mm (SD ± 6.5, range 9-40). On B-mode US, SNNs appeared hypoechoic in 14 cases (66.7 %), "target-like" in 7 cases (29.2 %), and homogeneously hyperechoic in 1 case (4.1 %). On CEUS, all lesions appeared devoid of contrast enhancement ("punched out" aspect) in the arterial, portal venous, and late phases after US contrast agent injection. A uniformly thin, hyperenhancing ring in the early arterial phase and isoenhanced with the surrounding parenchyma in the portal venous and late phases was found in 10 nodules (41.6 %). Clinical and imaging follow-up (mean duration 42.2 months, SD ± 34.9, range 2-108) was available in 15 patients with 16 SNNs: no changes in size and echostructure were seen. CONCLUSION CEUS can contribute to the diagnosis of SNN when a "punched out" appearance in all vascular phases with or without thin rim enhancement in the very early arterial phase is present in healthy subjects in whom a focal liver lesion is incidentally found. In patients with a history of chronic liver disease or malignancy, US-guided biopsy represents the unavoidable first-line diagnostic modality.
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Affiliation(s)
- Giampiero Francica
- Interventional Ultrasound Unit, Pineta Grande Srl, Castel Volturno, Italy
| | - Maria Franca Meloni
- Radiology, Casa di Cura Igea, Milano, Italy
- Radiology, University of Wisconsin-Madison, United States
| | - Laura Riccardi
- Internal Medicine and Gastroenterology, Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Roma, Italy
| | - Ilario de Sio
- Hepatogastroenterology, University of Campania Luigi Vanvitelli School of Medicine and Surgery, Napoli, Italy
| | | | - Fulvia Terracciano
- Gastroenterology, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Jason Chiang
- Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, United States
| | - Roberta Danzi
- Radiology, Pineta Grande Srl, Castel Volturno, Italy
| | - Antonella Marra
- Gastroenterology, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Marco Niosi
- Hepatogastroenterology, University of Campania Luigi Vanvitelli School of Medicine and Surgery, Napoli, Italy
| | | | - Maurizio Pompili
- Internal Medicine and Gastroenterology, Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Roma, Italy
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Wang J, Yi Q, Guo Y, Peng T. Spontaneous hepatic rupture during late pregnancy in a patient with solitary necrotic nodule of the liver: A case report. Front Med (Lausanne) 2022; 9:936006. [DOI: 10.3389/fmed.2022.936006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSpontaneous hepatic rupture (SHR) during pregnancy is a rare and life-threatening event, which usually occurs together with preeclampsia, eclampsia, HELLP syndrome, or liver tumors. However, SHR resulting from solitary necrotic nodule of the liver (SNNL) is extremely rare.Case presentationWe report the case of a 32-year-old pregnant woman who presented at 33 weeks of gestation with abdominal pain and emesis. Transabdominal ultrasound and magnetic resonance imaging revealed massive hemoperitoneum and lesions in the left lobe of the liver. An emergency cesarean section was performed and the hepatic rupture was managed surgically via left lateral lobectomy. The postprocedural course was uneventful. The premature baby successfully survived, and the patient was discharged 8 days after admission without complications. Histological examination revealed a diagnosis of SNNL, which resulted in the hepatic hematoma and SHR.ConclusionTo our knowledge, this is the first case of SHR resulting from SNNL during late pregnancy. Multidisciplinary collaboration and surgical management are important cornerstones for improving the perinatal outcomes when SHR is suspected in a pregnant patient.
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Bao JP, Tian H, Wang HC, Wang CC, Li B. Solitary necrotic nodules of the liver with "ring"-like calcification: A case report. World J Clin Cases 2022; 10:7409-7414. [PMID: 36158018 PMCID: PMC9353921 DOI: 10.12998/wjcc.v10.i21.7409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/22/2022] [Accepted: 06/03/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Solitary necrotic nodule of the liver (SNNL) is a rare benign lesion with a complete necrotic core and a clear fibrous capsule containing elastic fibers. We present the case of a patient with a radiographic computed tomography (CT) finding of "ring"-like annular calcification within the lesion and postoperative pathologic diagnosis of necrotic nodules wrapped by dense fibers in liver tissue, as well as the patient's subsequent management and outcome. CASE SUMMARY A 38-year-old Chinese woman with a history of systemic lupus erythematosus treated with prednisone and hydroxychloroquine, without any symptoms, was found to have hepatic space-occupying lesions by imaging examination at a health examination. A subsequent CT scan suggested a space-occupying lesion of the liver with annular calcification, which was not defined to be benign or malignant. After that, a laparoscopic hepatic space-occupying resection was performed. The postoperative pathological diagnosis was necrotic nodules wrapped by dense fibers in the liver tissue, and the final diagnosis was SNNL. The patient had an uneventful postoperative recovery. CONCLUSION There is a "ring"-like calcification in SNNL. This patient had a history of systemic lupus erythematosus, without a history of parasite infection, trauma, or tumor. Therefore, whether the etiology and pathological changes of SNNL are related to rheumatic immune diseases remains to be investigated.
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Affiliation(s)
- Jin-Peng Bao
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China
| | - Hu Tian
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China
| | - Hao-Chen Wang
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China
| | - Cong-Cong Wang
- Department of Gastroenterology, Shandong First Medical University, Jinan 250024, Shandong Province, China
| | - Bo Li
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250100, Shandong Province, China
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Peng YL, Liu LP, Zhang YJ, Liu JJ, Yu XL. Focal solitary necrotic nodules in fatty liver: characteristics on conventional and contrast-enhanced ultrasonography. J Ultrasound 2022; 25:847-854. [PMID: 35092601 DOI: 10.1007/s40477-021-00634-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Focal lesions in fatty liver are difficult to diagnose using conventional ultrasonography (CVUS). The aim of this study was to investigate the characteristics of solitary necrotic nodules (SNNs) in fatty liver using CVUS and contrast-enhanced ultrasonography (CEUS) and to evaluate the diagnostic value of CEUS for SNNs in fatty liver. METHODS Fifteen SNNs in the fatty liver of fifteen patients were examined by both CVUS and CEUS. The contrast agent SonoVue was used for CEUS. The characterization and shape of these SNNs in the fatty liver were analyzed using CEUS. RESULTS CVUS revealed eight oval-shaped, six irregularly shaped, and one wedge-shaped SNN in the fatty liver. The six irregularly shaped lesions on CVUS were revealed to comprise four gourd-shaped, one serpiginous, and one 3-pin socket-shaped nodule on CEUS. One of these SNNs showed a subcapsular wedge shape, with peripheral and distinct internal septal hyperenhancement in the arterial phases that washed out in the portal phase; moreover, most areas of th lesion showed no internal enhancement in any of the three phases. Fourteen of the lesions were characterized as lacking internal enhancement, and 12 of them had mild-moderate peripheral thin enhancement in the arterial phases. Twelve of the 15 nodules could be considered for diagnosis as SNNs by CEUS, which was further proved by US-guided biopsy and histopathology. However none of them could be considered for diagnosis as SNNs by CVUS. CONCLUSIONS CEUS is a valuable tool for visualizing the characteristics of SNNs in fatty liver to improve the differential diagnosis.
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Affiliation(s)
- Yue-Ling Peng
- Department of Nephrology, Shanxi People's Hospital, Taiyuan, 030001, China
| | - Li-Ping Liu
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Yan-Jing Zhang
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Jing-Jing Liu
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Xiao-Ling Yu
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, 28 Fuxing Rd, Beijing, 100853, China.
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Lu C, Tang S, Zhang X, Wang Y, Wang K, Shen P. Characteristics of hepatic solitary necrotic nodules on contrast-enhanced ultrasonography. BMC Gastroenterol 2021; 21:35. [PMID: 33494716 PMCID: PMC7836171 DOI: 10.1186/s12876-021-01608-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 01/12/2021] [Indexed: 11/20/2022] Open
Abstract
Background To summarize the characteristics of solitary necrotic nodules (SNN) in the liver observed under contrast-enhanced ultrasonography (CEUS). Methods Conventional ultrasonography (US) and CEUS were performed in 24 patients who were confirmed to have SNN by pathological assessment. The US data and dynamic enhancement patterns of CEUS were recorded and retrospectively analyzed. Results Ten of 24 patients underwent surgical resection, while the other 14 patients underwent a puncture biopsy to be confirmed as SNN. Among the 24 patients, 13 patients had a single lesion and 11 patients had multiple lesions. The largest lesion was selected for CEUS examination for patients with multiple lesions. Eleven patients presented no enhancement in all three phases, while the other 13 patients presented with a peripheral thin rim-like enhancement in the arterial phase, an iso-enhancement in the portal phase and delayed phase. However, no enhancement in the interior of the lesions was detected during three phases of CEUS. Conclusions SNN has characteristic findings on the CEUS, which play an important role in the differential diagnoses of liver focal lesions.
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Affiliation(s)
- Chunyu Lu
- Department of Ultrasound, Shengjing Hospital of China Medical University, 36 Sanhao St, Heping District, Shenyang, 110004, Liaoning Province, China
| | - Shaoshan Tang
- Department of Ultrasound, Shengjing Hospital of China Medical University, 36 Sanhao St, Heping District, Shenyang, 110004, Liaoning Province, China.
| | - Xiaoyue Zhang
- Department of Ultrasound, Shengjing Hospital of China Medical University, 36 Sanhao St, Heping District, Shenyang, 110004, Liaoning Province, China
| | - Yang Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, 36 Sanhao St, Heping District, Shenyang, 110004, Liaoning Province, China
| | - Kaiming Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, 36 Sanhao St, Heping District, Shenyang, 110004, Liaoning Province, China
| | - Peng Shen
- Department of Ultrasound, Shengjing Hospital of China Medical University, 36 Sanhao St, Heping District, Shenyang, 110004, Liaoning Province, China
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Mzoughi Z, Slama SB, Bacha D, Romdhane H, Bayar R, Sassi A, Lahmar A. [Solitary necrotic nodule of the liver: about two cases]. Pan Afr Med J 2017; 25:183. [PMID: 28292145 PMCID: PMC5326077 DOI: 10.11604/pamj.2016.25.183.10970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 10/24/2016] [Indexed: 11/23/2022] Open
Abstract
Les lésions hépatiques nodulaires sont majoritairement tumorales. Le nodule nécrotique solitire du foie est rare. Le diagnostic preopératoire est difficile. Il s'agit d'une femme âgée de 43 ans qui était opérée d'un adénocarcinome du rectum métastatique au foie opéré. Le scanner abdominal de surveillance a révélé un nodule hépatique d'allure métastatique. Le second cas est celui d'un homme de 56 ans, admis pour cholécystectomie avec découverte per-opératoire d'un nodule hépatique. Dans les deux cas, le nodule hépatique était sous capsulaire et a été réséqué. L'examen anatomopathologique posait le diagnostic de nodule nécrotique solitaire du foie. Le nodule nécrotique non spécifique du foie est une lésion qui doit être évoquée, même dans un contexte néoplasique. Une caractérisation par l'imagerie et une ponction biopsie des lésions hépatiques peut être utile.
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Affiliation(s)
- Zeineb Mzoughi
- Service de Chirurgie Viscérale, Hôpital Militaire Slim La Marsa, Tunisie; Université de Tunis El Manar, Faculté de Medecine de Tunis, 1007, Tunis, Tunisie
| | - Sana Ben Slama
- Université de Tunis El Manar, Faculté de Medecine de Tunis, 1007, Tunis, Tunisie; Service d'Anatomie Pathologique, Hôpital Militaire Slim La Marsa, Tunisie
| | - Dhouha Bacha
- Université de Tunis El Manar, Faculté de Medecine de Tunis, 1007, Tunis, Tunisie; Service d'Anatomie Pathologique, Hôpital Militaire Slim La Marsa, Tunisie
| | - Haifa Romdhane
- Université de Tunis El Manar, Faculté de Medecine de Tunis, 1007, Tunis, Tunisie; Service de Gastro-entérologie, Hôpital Militaire Slim La Marsa, Tunisie
| | - Rached Bayar
- Service de Chirurgie Viscérale, Hôpital Militaire Slim La Marsa, Tunisie; Université de Tunis El Manar, Faculté de Medecine de Tunis, 1007, Tunis, Tunisie
| | - Asma Sassi
- Service d'Anatomie Pathologique, Hôpital Militaire Slim La Marsa, Tunisie
| | - Ahlem Lahmar
- Université de Tunis El Manar, Faculté de Medecine de Tunis, 1007, Tunis, Tunisie; Service d'Anatomie Pathologique, Hôpital Militaire Slim La Marsa, Tunisie
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Goel G, Rao S, Khurana N, Sarda AK. Solitary Necrotic Nodule of Liver (SNNL): A Report of Two Cases. J Clin Diagn Res 2014; 8:115-6. [PMID: 24783098 DOI: 10.7860/jcdr/2014/5603.4127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 01/15/2014] [Indexed: 12/14/2022]
Abstract
SNNL is a rare, benign lesion which may arise from trauma, a sclerosing haemangioma or it may represent a burned out phase of various conditions like parasitic infections, or chronic infections like tuberculosis. Histopathology provides the definite diagnosis, which thus helps clinicians in allaying unnecessary anxiety of the patient and in planning proper management.We are reporting two cases here, which had solitary necrotic nodules of liver (SNNL), with emphasis on the aetiology and morphology of the lesions. SNNL was incidentally detected during cholecystectomy done in both young female patients. The lesion was solitary in one case and it was multiple in the other. The suspected aetiology in one of the cases was parasitic, whereas it was tuberculosis in the other. The clinical features in both cases were suggestive of neoplasms.
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Affiliation(s)
- Garima Goel
- Senior Resident, Department of Pathology and Surgery, Maulana Azad Medical College , New Delhi, India
| | - Seema Rao
- Assistant Professor, Department of Pathology and Surgery, Maulana Azad Medical College , New Delhi, India
| | - Nita Khurana
- Professor, Department of Pathology and Surgery, Maulana Azad Medical College , New Delhi, India
| | - A K Sarda
- Director Professor, Department of Pathology and Surgery, Maulana Azad Medical College , New Delhi, India
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Pananwala H, Pang TC, Eckstein RP, Hudson BJ, Newey A, Samra JS, Hugh TJ. The enigma of solitary necrotic nodule of the liver. ANZ J Surg 2012; 84:260-5. [PMID: 23137107 DOI: 10.1111/j.1445-2197.2012.06290.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Solitary necrotic nodule of the liver (SNNL) is a rare benign lesion with an uncertain aetiology. There are no typical diagnostic clinical or radiological features, and this lesion is usually detected incidentally during imaging for other purposes. METHODS We describe the clinical and radiological findings in three patients with histologically confirmed SNNL. The pertinent presenting features were documented and subsequent serological testing for parasites was performed. RESULTS All three patients underwent resection because it was not possible to exclude a solitary malignancy on preoperative imaging. All three nodules had a serpiginous shape with areas of necrosis that showed marked staining for eosinophil granules. However, no viable parasites were seen in any specimen. There were no specific radiological features that were present in all three patients. Two patients had travelled to areas where parasitic infections are endemic and one patient had an eosinophilia on presentation. The histopathological findings in conjunction with the clinical presentation suggest that SNNL may be parasitic in origin. CONCLUSION The diagnosis of SNNL is usually made after surgical excision. A preoperative diagnosis is difficult to make even with the use of multiple imaging modalities. The clinical and histopathological findings described in our three patients suggest that a transient parasitic infection is likely to be the cause in many cases. A history of potential exposure to parasites and serological testing for an eosinophilia or parasitic antibodies may help make the diagnosis of SNNL without the need for resection.
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Affiliation(s)
- Hasitha Pananwala
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, The University of Sydney, St Leonards, New South Wales, Australia
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Wang LX, Liu K, Lin GW, Zhai RY. Solitary Necrotic Nodules of the Liver: Histology and Diagnosis With CT and MRI. HEPATITIS MONTHLY 2012; 12:e6212. [PMID: 23087753 PMCID: PMC3475020 DOI: 10.5812/hepatmon.6212] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 05/31/2012] [Accepted: 06/09/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND A solitary necrotic nodule (SNN) of the liver is an uncommon lesion, which is different from primary and metastatic liver cancers. OBJECTIVES To analyze the classification, CT and MR manifestation, and the pathological basis of solitary necrotic nodule of the liver (SNN) in order to evaluate CT and MRI as a diagnosing tool. PATIENTS AND METHODS This study included 29 patients with liver SNNs, out of which 14 had no clinical symptoms and were discovered by routine ultrasound examinations, six were found by computed tomography (CT) due to abdominal illness, four had ovarian tumors, and five had gastrointestinal cancer surgeries, previously. Histologically, these SNNs can be divided into three subtypes, i.e., type I, pure coagulation necrosis (14 cases); type II, coagulation necrosis mixed with liquefaction necrosis (five cases); and type III, multi-nodular fusion (10 cases). CT and magnetic resonance imaging (MRI) patterns were shown to be associated with SNN histology. All patients were treated surgically with good prognosis. RESULTS CT AND MRI APPEARANCE AND CORRELATION WITH PATHOLOGY TYPES: three subtypes of lesions were hypo-density on both pre contrast and post contrast CT, 12 lesions were found the enhanced capsule and 1 lesion of multi- nodular fusion type showed septa enhancement. The lesions were hypo-intensity on T2WI and the lesions of type II showed as mixed hyperintensity on T2WI. The capsule showed delayed enhancement in all cases, and all lesions of multi- nodular fusion type showed delayed septa enhancement on MR images. 15 cases on CT were misdiagnosed and Four cases on MRI were misdiagnosed and the accuracy of CT and MRI were 48.3% and 86.2% respectively. CONCLUSIONS In conclusion, CT and MRI are useful tools for SNN diagnosis.
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Affiliation(s)
- Li Xia Wang
- Department of Radiology, Beijing Chaoyang Hospital, Capital University of Medical Sciences, Beijing, China
| | - Kan Liu
- Department of Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Guang Wu Lin
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, China
- Corresponding author: Guang Wu Lin, Department of Radiology, Huadong Hospital, Fudan University, Shanghai 200040, Shanghai, China. Tel.: +86-2162483180, Fax: +86-2162483180, E-mail:
| | - Ren You Zhai
- Department of Radiology, Beijing Chaoyang Hospital, Capital University of Medical Sciences, Beijing, China
- Corresponding author: Ren You Zhai, Department of Radiology, Beijing Chaoyang Hospital, Capital University of Medical Sciences, 8 Gongtinan Road, Chaoyang District, Beijing 100020, Beijing, China. Tel.: +86-1085231908, Fax: +86-1065935214, E-mail:
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Solitary Necrotic Nodules of the Liver: Histology and Diagnosis With CT and MRI. HEPATITIS MONTHLY 2012. [DOI: 10.5812/hapatmon.6212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Affiliation(s)
- Sang Jae Noh
- Department of Pathology and Research Institute for Endocrine Sciences, Chonbuk National University Medical School, Jeonju, Korea
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