Segmental atrophy of the liver: Review of a rare pseudotumor

Table 1 Clinical and pathologic features of reported segmental atrophy of the liver

Ref.	Gender	Age	Presentation	Coexisting conditions	Radiology findings	Procedure/treatment	Pathology findings	Follow-up
Singhi et al[1], N = 18	F = 13; M = 5	Mean age: 60.5 years (14-91)	Right upper abdominal pain (78%), ascites (11%), incidental mass (11%)	NA	Subcapsular mass in 83% of cases; size 18-10.0 cm (mean 5.2 cm)	Segmental resection (n = 3), wedge resection (n = 12); needle biopsies (n = 3)	Ranges from parenchymal collapse with hepatocyte islets/ductular proliferation to nodular elastosis with dense fibrosis	NA
Thomas et al[9]	M	54	Right-sided abdominal pain, progressive abdominal distention, and lower extremity edema for 3 weeks. History of alcoholic cirrhosis	NA	CT (triple phase scan): 1.7 cm × 2 cm intensely enhancing lesion with arterial attenuation but no washout on delayed phase images	Ultrasound-guided biopsy	Active alcoholic hepatitis with cirrhosis and segmental atrophy	NA
BedadaI et al[10]	F	4	2-year history of abdominal pain and a palpable mass	None	CT: 9 cm × 10 cm liver lesion with central hypodense and peripheral isodense areas in the left lobe	Complete lesion excision	Areas of elastosis to fibrosis, small islets of hepatocytes, liver parenchyma with fibrous tracts and mild bile duct proliferation. Thin-walled veins were present in the fibrous septa, with a few prominent vessels	No recurrence at 6 months
Li et al[11]	M	3	2-month history of progressively worsening right upper abdominal pain	None	CT: A large (9.2 cm × 7.4 cm × 13.3 cm) heterogeneous hypodense mass in the right liver lobe with cystic and solid components; the solid parts mildly enhanced post-contrast	Right hemi-hepatectomy	Hepatocyte atrophy fibrous tissue proliferation with collagenization, visible vasculature, and occasional dilated bile ducts	No recurrence at 12 months
Spolverato et al[12]	M	73	Incidental mass during laparoscopy for gastric conduit revision after esophageal cancer	None	NA	Segmental resection	Loss of parenchyma, mild inflammation, ductular proliferation, biliary retention cysts, early fibrosis/elastosis	NA
Spolverato et al[12]	M	74	Suspected cholangiocarcinoma	None	Left liver atrophy; possible mass in left hemi-liver	Left hemi-hepatectomy	Atrophic liver with marked inflammation, large bile ducts, and rare reactive epithelium (consistent with segmental atrophy)	NA
Spolverato et al[12]	M	73	Questionable lesion in pancreatic adenocarcinoma context	Pancreatic adenocarcinoma	NA	Wedge resection	Dense chronic inflammation with scarring and bile duct proliferation	NA
Ishizaki et al[13]	F	45	Asymptomatic, lesion found on routine ultrasound	None	CT: Low-density mass (10.5 cm × 7.5 cm) in anterior/medial segments, no enhancement	Central hepatectomy	Parenchyma replaced by fibrous tissue with elastic fibers, anomalous vessels, intimal thickening, thrombi, and recanalization	No recurrence at 5 years
Garg et al[14], N = 6	F = 6	Mean age: 58.3 years (37-80)	Incidental findings were noted in 5 cases during workup or surgery for nodules or tumors elsewhere in the body. One additional case presented with right upper abdominal pain	4/6: Lung adenocarcinoma (n = 1); pancreatic neuroendocrine tumor (n = 1); colorectal adenocarcinoma (n = 1); ovarian granulosa cell tumor (n = 1)	Single lesion in each patient; mean size 18 mm (range 3-36 mm)	NA	NA	NA
Findeis-Hosey et al[15], N = 10	F = 6; M = 4	Median age: 68 years (44-80)	All asymptomatic. Identified incidentally during whole-body imaging, surgery for carcinoma history, or autopsy	6/10: Colorectal adenocarcinoma (n = 2), breast carcinoma (n = 1), hepatocellular carcinoma (n = 1), pancreatic carcinoma (n = 1), and carcinoma of unknown primary (n = 1)	56% of cases had a single liver lesion, mean tumor size 16 mm	12 cases from 10 patients; segmental resections (n = 7); needle core biopsies (n = 5)	92% of cases showed elastic material and thick-walled vessels; 50% of cases have ductular proliferation; 17% of cases have biliary cysts and residual hepatocytes	NA

CT: Computed tomography; NA: Not available.