Clinical–Pathological Conference Series from the Medical University of Graz
Case No 154: 32–year–old computer software engineer with nodular mass in the liver
Presentation of case
Dr. W. Spindelboeck:
Due to episodic epigastric pain this 32-year-old woman had undergone computed tomography (CT) 20 months previously. Contrast enhanced CT showed a hypodense lesion between liver segments IV and VIII with a diameter of 4 cm and inhomogenous early enhancement suggesting hemangioma. Eight more lesions (diameter up to 1 cm) that were only visible in the early arterial phase were found in segments VI and III. Magnetic resonance imaging (MRI) 13 and 8 months before admission showed slight progression (from a diameter of 4.0 to 4.6 cm) of the lesion in segment IV. At that time, the lesion appeared to be lobulated with a central hyperintense scar and arterial enhancement, primarily compatible with “atypical” focal nodular hyperplasia (FNH). Except for occasional abdominal pain and a 10-year history of histamine intolerance, the patient was free of symptoms. She had taken thyroid replacement therapy (Euthyrox® 100 µg per day) for years; she had no previous surgery, had never received a blood transfusion, and was not vaccinated against hepatitis A or B; she neither smoked nor drank and her family history was unremarkable. The patient is a single parent of a healthy 10-year-old boy. Physical examination was unremarkable; she weighed 56 kg and her height was 174 cm. Except for lactate dehydrogenase (LDH:296 U/l, normal 120–240 U/l) routine laboratory tests were negative. A panel of antibodies to detect autoimmune and collagen vascular diseases was negative; thyroid stimulating hormone (TSH) was 1.3 µU/ml (normal 0.1–4.0 µU/l).
Elisabeth Fabian, Bernhard Haas, Patrizia Kump, Rainer Lipp, Peter Kornprat, Andre Lutfi, Emina Talakic, Michael Fuchsjäger, Walter Spindelboeck, Carolin Lackner, Gernot Zollner, Guenter Krejs, Wiener klinische Wochenschrift 7/8/2016