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Multiple hypervascular liver nodules in a heavy drinker of alcohol
Authors:Kim Soo Ryang  Maekawa Yoko  Ninomiya Toshiaki  Imoto Susumu  Matsuoka Toshiyuki  Ando Kenji  Mita Keiji  Ku Kwansong  Koterazawa Toshihiro  Nakajima Taisuke  Fukuda Katsumi  Yano Yoshihiko  Nakaji Miyuki  Kudo Masatoshi  Kim Ke Ih  Hirai Midori  Hayashi Yoshitake
Affiliation:Department of Gastroenterology, Kobe Asahi Hospital, Kobe, Japan.
Abstract:
A case of hypervascular nodules in the liver, but without hepatitis B or C virus infection in a 38-year-old woman with a history of alcohol abuse is presented. An ultrasound disclosed 1-2-cm hypoechoic tumors in the right and left lobes. Magnetic resonance imaging showed high-intensity tumors at both the T1-weighted and T2-weighted sequences. Incremental dynamic computed tomography and hepatic angiography revealed hypervascular tumors. Ultrasound-guided needle biopsy revealed no evidence of hepatocellular carcinoma, metastatic liver cancer, hemangioendothelioma, inflammatory pseudotumors or pseudolymphoma, but demonstrated stellate-scar fibrosis septa, which contained small unpaired arteries without hyperplasia dividing the nodule. Moreover, marked pericellular fibrosis, neutrophilic infiltration and Mallory bodies were observed in the cytoplasm. There was no evidence of bile duct proliferation. From these findings, the diagnosis of alcohol-induced fibrosis, distinctly different from focal nodular hyperplasia, was tenable. Further studies may provide insights into the pathogenesis of nodule formation and hypervascularity in heavy drinkers of alcohol.
Keywords:alcoholic hepatic fibrosis    heavy drinker    hypervascular nodule    unpaired artery
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