Solitary Necrotic Nodule of the Liver: Always Benign?

Department of Pathology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
Journal of Gastrointestinal Surgery (Impact Factor: 2.8). 12/2009; 14(3):536-40. DOI: 10.1007/s11605-009-1120-3
Source: PubMed


Solitary necrotic nodule of the liver (SNNL) is a rare lesion and accepted as a benign entity. The aim of this study is to investigate the possible causes for the development of solitary necrotic nodules.
Twenty-two retrospective solitary necrotic nodule specimens were examined to evaluate histologic features. The clinical records of these patients were reviewed, and clinical data were obtained for all patients.
Histologically, 17 of the 22 nodules were necrotic with surrounding fibrosis, and the remaining five nodules were completely fibrotic. Four of the 22 cases were found to have specific lesions within the nodules which may put light on the pathogenesis. Foci of metastatic carcinoma were identified in two of these four cases, and cuticle fragments of the hydatid cyst were identified in the other two cases. Clinical data showed that half of the cases with solitary necrotic nodule have an associated malignancy mainly involving the gastrointestinal system.
SNNL is not always benign. The possible causes of this lesion include parasites and metastatic tumors. It is important to identify the minute foci of metastatic carcinoma for the appropriate management of this lesion.

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    • "Thus, conservative treatment and management with close follow-up may be considered as a good treatment option for SNNs (3, 4). However, studies to date have also found that SNNs could contain foci of metastatic cancer cells that are mainly associated with a gastrointestinal malignancy (5), SNN etiology may include trauma, parasitic infection (6), and sclerosing hemangioma (7, 8). In any event, detection of SNNs in the liver has significantly increased with the evolution of imaging technology. "
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    ABSTRACT: A solitary necrotic nodule (SNN) of the liver is an uncommon lesion, which is different from primary and metastatic liver cancers. 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. 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. 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. In conclusion, CT and MRI are useful tools for SNN diagnosis.
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    ABSTRACT: Solitary necrotic nodules of the liver occur rarely. Although these nodules are usually benign, they are surgically removed in most cases because they cannot be differentiated from malignant lesions. To date, the natural history of solitary fibrous nodules remains unclear. We present the case of an incidentally detected hepatic mass (diameter 2 cm) in a 35-year-old man. The hepatic mass was diagnosed as a solitary necrotic nodule by liver biopsy. Follow-up radiologic examination revealed that the solitary necrotic nodule had spontaneously regressed. This is the first report on the natural course history of a solitary necrotic nodule.
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