Telangiectatic Hyperplastic Nodule Associated with Vascular Malformation in a Patient with Chronic Hepatitis B: Radiologic and Pathologic Features

Abstract

Recognizing hepatocellular nodules that cannot be classified as typical for hepatocellular carcinoma, hepatocellular adenoma, or focal nodular hyperplasia is important, especially in a patient with high risk for hepatocellular carcinoma. The authors report a case of a 53-year-old man with chronic hepatitis B, who was referred to the hospital with a liver mass found on routine imaging follow-up. Abdominal ultrasound revealed a 2.4-cm hypoechoic lesion. Contrast computed tomography showed homogeneous arterial enhancement and mild hyperdensity on portal venous phase images. Due to the high risk for hepatocellular carcinoma, the patient underwent laparoscopic left lateral segmentectomy that revealed a 2.2-cm poorly defined red-brown lesion. The nodule was diagnosed as a hypervascular/telangiectatic hyperplastic hepatocellular nodule based on histopathologic findings and immunostaining profile with negative glutamine synthetase, diffuse positive CD34 highlighting hyperplastic endothelial cells along the telangiectatic sinusoids and dilated vascular channels, and CK7 and CK19 reactive normal bile ducts within the lesion.

Keywords

telangiectatic hyperplastic nodule - liver mass - chronic hepatitis B - benign mass - vascular malformation

• References

• 1 Bruix J, Sherman M ; American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology 2011; 53 (3) 1020-1022
• 2 Colli A, Fraquelli M, Casazza G , et al. Accuracy of ultrasonography, spiral CT, magnetic resonance, and alpha-fetoprotein in diagnosing hepatocellular carcinoma: a systematic review. Am J Gastroenterol 2006; 101 (3) 513-523
• 3 Forner A, Vilana R, Ayuso C , et al. Diagnosis of hepatic nodules 20.  mm or smaller in cirrhosis: prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology 2008; 47 (1) 97-104
• 4 Sangiovanni A, Manini MA, Iavarone M , et al. The diagnostic and economic impact of contrast imaging techniques in the diagnosis of small hepatocellular carcinoma in cirrhosis. Gut 2010; 59 (5) 638-644
• 5 Khalili K, Kim TK, Jang HJ , et al. Optimization of imaging diagnosis of 1-2 cm hepatocellular carcinoma: an analysis of diagnostic performance and resource utilization. J Hepatol 2011; 54 (4) 723-728
• 6 Vilgrain V. Focal nodular hyperplasia. Eur J Radiol 2006; 58 (2) 236-245
• 7 Faria SC, Iyer RB, Rashid A, Whitman GJ. Hepatic adenoma. AJR Am J Roentgenol 2004; 182 (6) 1520
• 8 Katabathina VS, Menias CO, Shanbhogue AK, Jagirdar J, Paspulati RM, Prasad SR. Genetics and imaging of hepatocellular adenomas: 2011 update. Radiographics 2011; 31 (6) 1529-1543
• 9 Grazioli L, Bondioni MP, Haradome H , et al. Hepatocellular adenoma and focal nodular hyperplasia: value of gadoxetic acid-enhanced MR imaging in differential diagnosis. Radiology 2012; 262 (2) 520-529
• 10 Silva AC, Evans JM, McCullough AE, Jatoi MA, Vargas HE, Hara AK. MR imaging of hypervascular liver masses: a review of current techniques. Radiographics 2009; 29 (2) 385-402
• 11 Vilgrain V, Boulos L, Vullierme MP, Denys A, Terris B, Menu Y. Imaging of atypical hemangiomas of the liver with pathologic correlation. Radiographics 2000; 20 (2) 379-397
• 12 Leslie DF, Johnson CD, Johnson CM, Ilstrup DM, Harmsen WS. Distinction between cavernous hemangiomas of the liver and hepatic metastases on CT: value of contrast enhancement patterns. AJR Am J Roentgenol 1995; 164 (3) 625-629
• 13 Burt A, Portman B, Ferrell L. Tumours and tumour-like lesions of the liver. In: MacSween's Pathology of the Liver. 6th ed. Philadelphia, PA: Churchill Livingstone; 2011: 761-851
• 14 Nguyen BN, Fléjou JF, Terris B, Belghiti J, Degott C. Focal nodular hyperplasia of the liver: a comprehensive pathologic study of 305 lesions and recognition of new histologic forms. Am J Surg Pathol 1999; 23 (12) 1441-1454
• 15 Paradis V, Benzekri A, Dargère D , et al. Telangiectatic focal nodular hyperplasia: a variant of hepatocellular adenoma. Gastroenterology 2004; 126 (5) 1323-1329
• 16 Attal P, Vilgrain V, Brancatelli G , et al. Telangiectatic focal nodular hyperplasia: US, CT, and MR imaging findings with histopathologic correlation in 13 cases. Radiology 2003; 228 (2) 465-472
• 17 Shafizadeh N, Kakar S. Diagnosis of well-differentiated hepatocellular lesions: role of immunohistochemistry and other ancillary techniques. Adv Anat Pathol 2011; 18 (6) 438-445
• 18 Bioulac-Sage P, Laumonier H, Rullier A , et al. Over-expression of glutamine synthetase in focal nodular hyperplasia: a novel easy diagnostic tool in surgical pathology. Liver Int 2009; 29 (3) 459-465
• 19 Ahmad I, Iyer A, Marginean CE , et al. Diagnostic use of cytokeratins, CD34, and neuronal cell adhesion molecule staining in focal nodular hyperplasia and hepatic adenoma. Hum Pathol 2009; 40 (5) 726-734
• 20 Coston WM, Loera S, Lau SK , et al. Distinction of hepatocellular carcinoma from benign hepatic mimickers using Glypican-3 and CD34 immunohistochemistry. Am J Surg Pathol 2008; 32 (3) 433-444
• 21 Nolte M, Werner M, Nasarek A , et al. Expression of proliferation associated antigens and detection of numerical chromosome aberrations in primary human liver tumours: relevance to tumour characteristics and prognosis. J Clin Pathol 1998; 51 (1) 47-51
• 22 Wanless IR, Lentz JS, Roberts EA. Partial nodular transformation of liver in an adult with persistent ductus venosus. Review with hypothesis on pathogenesis. Arch Pathol Lab Med 1985; 109 (5) 427-432
• 23 Shimamatsu K, Wanless IR. Role of ischemia in causing apoptosis, atrophy, and nodular hyperplasia in human liver. Hepatology 1997; 26 (2) 343-350
• 24 Tanaka M, Wanless IR. Pathology of the liver in Budd-Chiari syndrome: portal vein thrombosis and the histogenesis of veno-centric cirrhosis, veno-portal cirrhosis, and large regenerative nodules. Hepatology 1998; 27 (2) 488-496