Article

Enlarged solitary necrotic nodule of the liver misinterpreted as a metastatic liver cancer

Clinical Journal of Gastroenterology 01/2009; 2(5):355-360. DOI: 10.1007/s12328-009-0103-y

ABSTRACT Solitary necrotic nodule of the liver is a rare nonmalignant lesion of unknown etiology. It is defined as a nodule with a
completely necrotic core enclosed by a hyalinized fibrotic capsule containing elastic fiber. We report a 74-year-old woman
with a solitary necrotic nodule of the liver that mimicked metastasis from a previous rectal adenocarcinoma. She was referred
to us for an asymptomatic liver nodule in segment 8 that had increased in diameter from 5 to 15mm over the past 8months.
Ultrasonography showed a well-defined, oval, hypoechoic mass, and computed tomography showed a hypodense area without contrast
enhancement except for a ring-like enhancement during hepatic arteriography. Magnetic resonance imaging revealed a mass that
was hypointense on T1-weighted imaging and slightly hyperintense on T2-weighted imaging. The patient underwent hepatectomy
of segment 8. The resected specimen contained an oval nonencapsulated nodule with firm and gritty consistency and a well-defined
margin. Histologic findings were compatible with those of solitary necrotic nodule. Clinicians should recognize the existence
of this lesion as one of the differential diagnoses of metastatic liver nodule. Solitary necrotic nodules can change size,
and when enlarged, differentiation from metastasis is extremely difficult.

KeywordsNecrotic nodule-Liver-Metastasis

0 Bookmarks
 · 
126 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Solitary necrotic nodule of the liver is an unusual lesion that is often an incidental finding on abdominal imaging, intraoperative examination, or post mortem. Most reported cases of solitary necrotic nodule have been in males, and over three quarters of these lesions have occurred in the right lobe of the liver. Pathologically, solitary necrotic nodule is a benign lesion characterized by a completely necrotic core that is often partly calcified, surrounded by a dense hyalinized fibrous capsule containing elastin fibres. The ultrasound appearance of solitary necrotic nodule is usually of a "target" lesion with a hyperechoic center, while on CT scan they appear as non-enhancing hypodense lesions that are typical of metastatic adenocarcinoma or peripheral cholangiocarcinoma. The impression of malignancy is further enforced with the finding of necrotic cellular material on biopsy and the macroscopically hard and "gritty" nature of the nodules. Currently, permanent histopathology of solitary necrotic nodules is the only accurate method of diagnosis. However, solitary necrotic nodules are usually of a bilobed or lobulated shape that is unusual for malignant liver lesions, and they often lie in close proximity to hepatic inflow structures. Solitary necrotic nodule should be suspected in liver lesions with this configuration, location, and on a biopsy showing a large amount of necrosis.
    Journal of Gastrointestinal Surgery 01/2003; 7(5):627-30. · 2.36 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to assess the additional value of information provided by positron emission tomography (PET) with [(18)F]fluoro-2-deoxy-D-glucose (FDG) over that provided by computed tomography (CT) in patients with resectable liver metastases from colorectal cancer. Between October 2001 and November 2002, a prospective double-blind comparison of preoperative FDG-PET and thoracoabdominal CT was performed in 53 patients with potentially resectable liver metastases from colorectal cancer. All resected metastases were subjected to histological examination. Histological examination confirmed the presence of malignant or benign lesions detected by PET and/or CT in 95 per cent of instances. Overall sensitivity (78 per cent) and accuracy (88 per cent) of PET were equivalent to those of CT (76 and 86 per cent respectively). The sensitivity of PET was equivalent to that of CT for hepatic sites (both 79 per cent), but was superior for extrahepatic abdominal sites (63 and 25 per cent respectively). PET provided additional information in five patients, mainly by revealing abdominal extrahepatic metastases, but falsely upstaged three patients. Whole-body FDG-PET may identify unrecognized extrahepatic metastases in patients with potentially resectable liver metastases imaged by CT. However, additional information provided by PET is not as reliable as suggested by earlier retrospective studies.
    British Journal of Surgery 04/2005; 92(3):362-9. · 4.84 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In our experience, we document 2 cases of a rare and non-tumoral lesion of the liver misinterpreted as necrotic tumor: necrotic solitary nodule. In the first clinical case, ultrasound (US) showed a polylobated lesion (35 x 35 x 38 mm) at segment 8. Color-doppler identified a compression of celiac axis (Dunbar syndrome). Arteriography revealed a subtotal stenosis of celiac tripod soon after the emergence of the left gastric artery. FNAB-CT showed a highly cellulated tissue with a necrotic core surrounded by a fibersclerotic tissue. The patient underwent surgery: cholecystectomy and correction of Dunbar syndrome. US follow-up showed a progressive reduction in diameter of the lesion (24 x 25 x 25 mm at 24 months), suggesting in this case the role of ischemic injury in the pathogenesis of the lesion. In the second clinical case, a hypoechoic lesion (32 x 32 x 30 mm) of segment 6 as occasional US finding during the staging for prostate cancer was shown. FNAC-CT showed a positive result for necrotic cells. Surgical treatment consisted in a wide excision of the lesion. Histologically the lesion was solitary necrotic nodule. The diagnosis of this rare lesion is accidental. In accordance with the literature (50% of cases), we founded an associated tumor. Radiology doesn't differentiate solitary necrotic nodule and other solid lesions. Diagnosis is histological (in our second case, FNAC-CT misinterpreted the tumor as a malignant lesion, while histology showed the real nature of it).
    Journal of Surgical Oncology 08/2000; 74(3):219-22. · 2.64 Impact Factor