title: Multiple liver lesions in a patient with Budd-Chiari syndrome secondary to polycythemia vera.
abstract: Focal nodular hyperplasia and nodular regenerative hyperplasia are occasionally seen in patients with hepatic venous outflow obstruction as a consequence of circulatory stress in the liver. In addition, neoplastic processes such as hepatic adenoma, hepatocellular carcinoma, and metastatic disease may arise in these patients. Histologic evaluation is necessary when imaging modalities are unable to distinguish these lesions. We present a case of multiple hepatic lesions, suspicious for metastases, in a patient with Budd-Chiari syndrome secondary to polycythemia vera. However, the biopsy findings were consistent with focal nodular hyperplasia. Budd-Chiari syndrome may be associated with multiple nodules of focal nodular hyperplasia, which may be difficult to diagnose radiologically.
authors.affiliation: Department of Pathology Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Juan
authors.initials: J
authors.lastname: Putra
authors.affiliation: Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Arifa
authors.initials: A
authors.lastname: Toor
authors.affiliation: Department of Radiology, Dartmouth-Hitchcock Manchester, Manchester, NH, USA.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Noce
authors.affiliation: Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Swan N
authors.initials: SN
authors.lastname: Thung
authors.affiliation: Department of Pathology Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Arief A
authors.initials: AA
authors.lastname: Suriawinata
authors.affiliation: Department of Pathology Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Lisovsky
mesh_terms: D001706:Biopsy; D006502:Budd-Chiari Syndrome / Q000175:diagnosis / Q000209:etiology*; D003937:Diagnosis, Differential; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008113:Liver Neoplasms / Q000556:secondary*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011087:Polycythemia Vera / Q000150:complications* / Q000175:diagnosis; D011237:Predictive Value of Tests; D012307:Risk Factors