title: Solitary necrotic nodule of the liver misinterpreted as malignant lesion: considerations on two cases.
abstract: In our experience, we document 2 cases of a rare and non-tumoral lesion of the liver misinterpreted as necrotic tumor: necrotic solitary nodule. In the first clinical case, ultrasound (US) showed a polylobated lesion (35 x 35 x 38 mm) at segment 8. Color-doppler identified a compression of celiac axis (Dunbar syndrome). Arteriography revealed a subtotal stenosis of celiac tripod soon after the emergence of the left gastric artery. FNAB-CT showed a highly cellulated tissue with a necrotic core surrounded by a fibersclerotic tissue. The patient underwent surgery: cholecystectomy and correction of Dunbar syndrome. US follow-up showed a progressive reduction in diameter of the lesion (24 x 25 x 25 mm at 24 months), suggesting in this case the role of ischemic injury in the pathogenesis of the lesion. In the second clinical case, a hypoechoic lesion (32 x 32 x 30 mm) of segment 6 as occasional US finding during the staging for prostate cancer was shown. FNAC-CT showed a positive result for necrotic cells. Surgical treatment consisted in a wide excision of the lesion. Histologically the lesion was solitary necrotic nodule. The diagnosis of this rare lesion is accidental. In accordance with the literature (50% of cases), we founded an associated tumor. Radiology doesn't differentiate solitary necrotic nodule and other solid lesions. Diagnosis is histological (in our second case, FNAC-CT misinterpreted the tumor as a malignant lesion, while histology showed the real nature of it).
authors.affiliation: General and Oncological Surgery, University Federico II, Naples, Italy. forestie@unina.it
authors.forename: M
authors.initials: M
authors.lastname: De Luca
authors.forename: B
authors.initials: B
authors.lastname: Luigi
authors.forename: C
authors.initials: C
authors.lastname: Formisano
authors.forename: A
authors.initials: A
authors.lastname: Formato
authors.forename: C
authors.initials: C
authors.lastname: De Werra
authors.forename: M
authors.initials: M
authors.lastname: Cappuccio
authors.forename: A
authors.initials: A
authors.lastname: Loffredo
authors.forename: P
authors.initials: P
authors.lastname: Forestieri
mesh_terms: D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008107:Liver Diseases / Q000473:pathology*; D008113:Liver Neoplasms / Q000473:pathology*; D008297:Male; D009336:Necrosis