A 40-year-old patient came to the outpatient clinic of the gastroenterology service for a routine examination of elevated transaminase levels.
Abdominal ultrasound detected a 4 cm-long LOE in liver segments 2 and 3 with solid characteristics compatible with the diagnosis of hepatoma.
Multislice abdominal computed axial tomography (CAT) showed in segments 2 and 3 a focal lesion of lobulated edges measuring 4 cm in diameter, which enhanced the portal-contrast finding in an intensely washed phase.
No evidence of other focal lesions.
The intrahepatic bile duct did not show gall bladder or gallstone images.
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Puncture aspiration with needle (PAAF) of the lesion was performed under ultrasound guidance with a negative result for malignant cells and a positive CD 34 in the immunohistochemical study.
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The systematic blood analysis was normal, as well as liver function, determination of immunoglobulins, antibodies and tumor markers.
Viral markers were also negative.
Diagnosis of probable hepatoma on non-cirrhotic liver was decided by surgical resection.
Segment 2 and 3 were resected by laparoscopy through two ports of No. 12, periumbilical and in the right hypochondrium, and a gel port in the left hypochondrium.
Intraoperative histological study diagnosed hepatocellular proliferation without histological signs of malignancy leaving the lesion 2 cm from the edge of surgical resection.
In the anatomopathological study, the nodular formation presented a hepatic tissue with a compact trabecular pattern of up to 3 cell layers, with proliferation of large muscular arteries surrounded by a dense connective stroma, where they are not identified.
The pathological diagnosis was focal nodular hyperplasia.
The postoperative course was uneventful and the patient was discharged on the fourth postoperative day.
