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Case 20 - Hepatocellular carcinoma mimicking focal nodular hyperplasia

from Section 2 - Liver

Published online by Cambridge University Press:  05 November 2011

Fergus V. Coakley
Fergus V. Coakley
Affiliation:
University of California, San Francisco
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Summary

Imaging description

At MRI, focal nodular hyperplasia appears as a mass that is mildly hypointense on T1-weighted images, mildly hyperintense on T2-weighted images, hypervascular after gadolinium administration, and has a central scar that is of high T2 signal with delayed enhancement after gadolinium [1–4]. When all these findings are present, the diagnosis of focal nodular hyperplasia can usually be made with high accuracy [2,5]. However, hepatocellular carcinoma arising in a cirrhotic liver can demonstrate all of these features and so a diagnosis of focal nodular hyperplasia in a patient with cirrhosis should be made with great caution (Figures 20.1 and 20.2) [6].

Importance

Hepatocellular carcinoma has a wide spectrum of findings including an appearance indistinguishable from focal nodular hyperplasia. As such, hepatocellular carcinoma should be the primary consideration for any solid lesion in a cirrhotic liver that is not a hemangioma [2]. This approach may result in earlier diagnosis and treatment of hepatocellular carcinoma and prevent inappropriate management resulting from a potentially mistaken diagnosis of focal nodular hyperplasia.

Typical clinical scenario

The possibility of hepatocellular carcinoma mimicking focal nodular hyperplasia arises primarily in patients with cirrhosis, of whatever etiology. The diagnosis of cirrhosis is usually obvious due to the presence of diffuse hepatic nodularity and signs of portal hypertension.

Type
Chapter
Information
Pearls and Pitfalls in Abdominal Imaging
Pseudotumors, Variants and Other Difficult Diagnoses
 , pp. 64 - 67
Publisher: Cambridge University Press
Print publication year: 2010

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References

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