Regenerative nodule mimicking hepatocellular carcinoma in a cirrhotic child due to hepatitis B: an imaging dilemma.
Viral hepatitis B, post-hepatitic cirrhosis and hepatocellular carcinoma (HCC) is the classical sequence of events in hepatitis B virus (HBV) infected children and serum Alpha-fetoprotein (AFP) and ultrasound (USG) screening is recommended during follow up. We present a 13-yr-old girl with cirrhosis related to chronic HBV infection with normal AFP level and a 4 cm mass appearance by USG. Contrast spiral evaluation computed tomography (CT) study demonstrated a single mass located at 8th segment of the liver. Pre-contrast CT and portal venous phase studies showed heterogeneous liver parenchyma without mass appearance. HCC was suspected based on strong arterial enhancement. Two mediastinal lymphadenopathies, 1 cm under the xyphoid and 2 cm above the pericardium, were detected by thorax CT. Mediastinal exploration was undertaken with living related liver transplant donor in a second operating room. She was transplanted with the right lobe of her ABO compatible mother after evaluation of the lymph nodes revealed reactive histology by frozen section. Histologic evaluation of the explant liver documented cirrhosis with a cirrhotic nodule without histologic malignant evidence. False negative results from screening methods are familiar in the literature; however false positivity of a contrast CT study is rare. The significance of screening methods is discussed.
Ozgenç
Funda
F
Department of Pediatric Gastroenterology and Nutrition, Ege University, School of Medicine, Bornova, Izmir, Turkey. ozgenc@med.ege.edu.tr
Aydoğdu
Sema
S
Aksoylar
Serap
S
Elmas
Nevra
N
Yüce
Gül
G
Yağci
Raşit V
RV
Tokat
Yaman
Y
D000293:Adolescent; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D019694:Hepatitis B, Chronic / Q000821:virology*; D006801:Humans; D008103:Liver Cirrhosis / Q000821:virology*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008115:Liver Regeneration; D016031:Liver Transplantation; D011856:Radiographic Image Enhancement; D036542:Tomography, Spiral Computed; D014057:Tomography, X-Ray Computed