title: A case of multiple macronodular hepatic tuberculosis difficult to differentiate from hepatocellular carcinoma with intrahepatic metastasis: CT-guided fine needle aspiration biopsy confirmed the diagnosis.
abstract: Multiple macronodular hepatic tuberculosis is difficult to be differentiated from hepatocellular carcinoma with intrahepatic metastasis in clinical practice, especially when hepatitis B with or without liver cirrhosis coexists with it. Herein, we report a 30-year-old man with a 10-year history of hepatitis B and a family medical history of hepatocellular carcinoma related with hepatitis B that was finally diagnosed as multiple macronodular hepatic tuberculosis. Abdominal B-mode ultrasonography (US) and plain computed tomography (CT) revealed multiple unequal-sized nodules in the liver. CT-guided fine needle aspiration biopsy (FNAB) of the liver demonstrated a caseating granuloma with lymphocytes, multinucleate giant cells and epithelioid cells compatible with the diagnosis of tuberculosis and no hepatoma cells were detected. Thus, the diagnosis of hepatic tuberculosis was confirmed and hepatocellular carcinoma with intrahepatic metastasis was excluded.
authors.affiliation: Department of Infection and Liver Diseases, The First Affiliated Hospital of Wenzhou Medical University Wenzhou, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Infection and Liver Diseases, The First Affiliated Hospital of Wenzhou Medical University Wenzhou, China.
authors.forename: Nai-Bin
authors.initials: NB
authors.lastname: Yang
authors.affiliation: Department of Infection and Liver Diseases, The First Affiliated Hospital of Wenzhou Medical University Wenzhou, China.
authors.forename: Shun-Lan
authors.initials: SL
authors.lastname: Ni
authors.affiliation: Department of Infection and Liver Diseases, The First Affiliated Hospital of Wenzhou Medical University Wenzhou, China.
authors.forename: Sai-Nan
authors.initials: SN
authors.lastname: Zhang
authors.affiliation: Department of Gastroenterology, Zhejiang Provincial People's Hospital Hangzhou, Zhejiang, China.
authors.forename: Chen-Bo
authors.initials: CB
authors.lastname: Shen
authors.affiliation: Department of Infection and Liver Diseases, The First Affiliated Hospital of Wenzhou Medical University Wenzhou, China.
authors.forename: Ming-Qin
authors.initials: MQ
authors.lastname: Lu
mesh_terms: D000328:Adult; D044963:Biopsy, Fine-Needle; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D003937:Diagnosis, Differential; D006801:Humans; D061705:Image-Guided Biopsy; D008113:Liver Neoplasms / Q000473:pathology*; D008297:Male; D014057:Tomography, X-Ray Computed; D014386:Tuberculosis, Hepatic / Q000175:diagnosis*
keywords: FNAB; Multiple macronodular hepatic tuberculosis; hepatocellular carcinoma; intrahepatic metastasis