Nodular focal fat sparing of liver mimicking hepatocellular
A 37-year-old male complained of mild right epigastric pain for 3 days when he came to our hospital. He had a history of hepatitis B virus (HBV) infection for 16 years, and alcohol abuse for 15 years. There was nothing special about his physical examination.

Routine blood tests showed an elevation of triglyceride (2.83 mmol/L) (normal range, 0.29–1.83 mmol/L). HBV test showed that HBsAb, HBeAb, and HBcAb were positive. Serum level of HBV DNA was <10,000 copies/mL. Tumor markers (alpha fetoprotein, carcinoembryonic antigen, carbohydrate antigen 19-9) were negative.

His conventional ultrasound examination illustrated a hypoechoic, not well-circumscribed, nodular lesion on Segment VI, compared with the hyperechoic and coarse liver parenchyma. The size of the lesion was about 2.8 × 2.0 cm. Then, CEUS examination using contrast agent SonoVue was performed. Compared with background liver parenchyma, the lesion presented a slight and homogeneous hyperenhancement in the arterial phase (about 0–29 seconds after injection of contrast agent), an iso-enhancement in the portal venous phase (about 30–89 seconds after injection), and a slight and homogeneous washout in the delayed phase (more than 90 seconds after injection). Contrast-enhanced CT showed a similar enhancement mode of the lesion with CEUS. Two imaging examinations indicated a diagnosis of HCC.

A combined imaging finding with his history of long-term HBV infection and alcohol abuse, a clinical diagnosis of HCC was made. Therefore, the patient underwent partial hepatectomy of the right lobe. Postoperative histopathologic test revealed an extensive hepatocellular steatosis (more than 75%) of background liver parenchyma, visible regenerate hepatocyte and proliferative Kupffer cell, and an area of normal hepatic structure. No round or polygonal liver cell with clear or eosinophilic cytoplasm and dense nuclei was found.

After general postoperative administration, the patient was told to discharge. Then, he had been undergoing regular serological tests and imaging examinations in our hospital for 39 months, and found no manifestation of liver tumor. Ethical approval was not required, because this paper is a case report with the clinical information of the patient.

Source: Medicine: May 2019 - Volume 98 - Issue 22 - p e15431

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