A 46-year-old woman with a history of hyperplastic gastric polyp resected 3 years ago.
Patient with chronic illness.
Acetatomised in 1995.
User of oral contraceptives for 17 years.
No alcoholic or smoking history.
Abdominal ultrasound (US) was performed due to mild dyspeptic symptoms, finding a 5 cm hypoechogenic solid hepatic nodule, hypervascular at doppler.
1.
Magnetic resonance imaging (MRI) showed a 5 x 6 cm nodule at the lower edge of segment VI, slightly hyperintense and heterogeneous at T1, with no signal drop in sequence out of phase, slightly hyperintense.
After injection of intravenous gadolinium into the arterial phase, an important centrifugal enhancement was observed, with a partially delimited peripheral hypointense ring.
In the venous phase, its signal was homogeneously reinforced and in the equilibrium phase, a homogeneous hyperintense appeared.
The possibility of an atypical hemangioma was raised due to the low hypersignal on T2-weighted images and the hypointense peripheral ring on arterial phase, unusual of hemangiomas.
1.
Liver tests, blood count, HIV, hepatitis B and C virus and alpha fetoprotein were normal.
Unenhanced computed tomography (CT) showed a hypodense homogeneous nodule with no calcifications.
In the arterial phase, it was heterogeneous hypervascular with full filling with a peripheral hypodense ring.
Portal and late phase showed central contrast lavage with moderate peripheral reinforcement, with a tenuous peripheral dense ring.
The possibility of hepatocellular injury, focal nodular hyperplasia or hepatocellular carcinoma was raised.
1.
In the radiological clinical discussion, it was decided to perform a resective surgery of the VI segment, progressing without incidents.
A fragment of hepatic tissue of 8.5 x 7 x 4 cm was used for the anatomopathological study. At the cut, a brownish nodular area received a 4.5 cm irregular axis in relation to the slightly irregular axis, with a slightly irregular axis.
The microscopic appearance revealed multiple irregular spaces with alteration of the reticular pattern containing reticular material and some macrophages.
They were intercalated and in parts surrounded by liver tissue preserved with focal macrovacuolar steatosis, findings suggestive of liver peliosis.
1.
At 18 months follow-up, the patient is asymptomatic.
Control US does not show focal lesions.
Your condom use
