title: Hepatic pseudotumor in long-standing biliary atresia patients undergoing liver transplantation.
abstract: A pseudotumor, giant regenerative nodule, or macroregenerative nodule is an unusual benign hepatic lesion in biliary atresia (BA) patients. This tumor may mimic malignant transformation and may preclude liver transplantation (LT). The clinical and imaging surveillance of patients after the Kasai procedure is therefore an important aspect of management of BA patients. Our objective is to report our experience and describe the incidence, imaging, and pathologic features of pseudotumors in BA patients awaiting LT. From August 1990 to December 2006, 133 LTs for BA were performed. Five (3.8%; 4 female, 1 male) patients were diagnosed with pseudotumor. The patients' records were reviewed. The diagnostic imaging modalities used were abdominal ultrasound (US), computed tomography (CT) scan, and magnetic resonance imaging (MRI). Histologic confirmation of the lesions was obtained in all cases. All underwent the Kasai operation in early infancy. Six of 7 lesions in 4 of 5 patients were demonstrated by pretransplant imaging. Two of 7 tumors were detected by US. Five of 7 lesions were detected by CT, and 5 of 7 lesions were demonstrated by MRI. In 1 patient, the lesion was not seen in the US, CT, or MRI but was found during surgery and confirmed by histology. An additional tumor was found incidentally during histologic examination in a patient previously diagnosed to have 2 tumors by CT and MRI. In another patient diagnosed to have 2 tumors on imaging, pathology revealed only a single tumor. In conclusion, although unusual, pseudotumor should be included in the differential diagnosis of liver masses in BA children.
authors.affiliation: Liver Transplantation Program, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Yueh-Wei
authors.initials: YW
authors.lastname: Liu
authors.forename: Allan M
authors.initials: AM
authors.lastname: Concejero
authors.forename: Chao-Long
authors.initials: CL
authors.lastname: Chen
authors.forename: Yu-Fan
authors.initials: YF
authors.lastname: Cheng
authors.forename: Hock-Liew
authors.initials: HL
authors.lastname: Eng
authors.forename: Tung-Liang
authors.initials: TL
authors.lastname: Huang
authors.forename: Tai-Yi
authors.initials: TY
authors.lastname: Chen
authors.forename: Chih-Chi
authors.initials: CC
authors.lastname: Wang
authors.forename: Shih-Ho
authors.initials: SH
authors.lastname: Wang
authors.forename: Chih-Che
authors.initials: CC
authors.lastname: Lin
authors.forename: Chee-Chien
authors.initials: CC
authors.lastname: Yong
authors.forename: Chin-Hsiang
authors.initials: CH
authors.lastname: Yang
authors.forename: Amornetta P
authors.initials: AP
authors.lastname: Jordan
authors.forename: Bruno
authors.initials: B
authors.lastname: Jawan
mesh_terms: D000293:Adolescent; D000328:Adult; D001656:Biliary Atresia / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006104:Granuloma, Plasma Cell / Q000473:pathology*; D006801:Humans; D008107:Liver Diseases / Q000473:pathology*; D008113:Liver Neoplasms / Q000473:pathology; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography