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Large benign hepatocellular nodules in cirrhosis due to chronic venous outflow obstruction: diagnostic confusion with hepatocellular carcinoma.

Abstract：

:Budd-Chiari syndrome (BCS) in patients progressing to cirrhosis is an indication for liver transplantation. At this stage of disease, it is common to find large benign hepatocellular nodules (LBHNs) of undetermined cause that may be confused with hepatocellular carcinoma (HCC). Patients with indications for liver transplantation are currently classified according to the MELD (Model for End-Stage Liver Disease) severity score. When they fit Barcelona and Milan eligibility criteria for HCC, they receive 20 points. Thus, misdiagnosis of HCC leads to a privileged position on the waiting list. Herein, we have reported three BCS cases of cirrhotic patients who underwent liver transplantation; the pathologic results of their explanted livers showed LBHN. We analyzed three of 489 OLT who had chronic venous outflow obstruction (CVOO) the first case: was a 19-year-old man, with BCS of undetermined cause. The second 20-year-old female patients displayed BCS due to antiphospholipid syndrome the third, 45-year-old man had CVOO diagnosed preliminarily due to cryptogenic cirrhosis in the explanted liver. In the three cases, the nodules in the explant measured 0.5 to 2.4 cm. In the first case, the diagnosis was not in doubt; in the second case, 23 nodules were confused with HCC histologic evaluation, and in the third case three larger hypervascular nodules were misdiagnosed as HCC in the preoperative period despite low alpha-fetoprotein levels. In conclusion it is fundamental to recognize these benign lesions so as to avoid misdiagnosis, thereby allowing the proper selection of candidates for liver transplantation.

journal_name

Transplant Proc

journal_title

Transplantation proceedings

authors

Oliveira EC,Duarte AG,Boin IF,Almeida JR,Escanhoela CA

doi

10.1016/j.transproceed.2010.09.070

subject

Has Abstract

pub_date

2010-12-01 00:00:00

pages

4116-8

issue

10

eissn

0041-1345

issn

1873-2623

pii

S0041-1345(10)01398-9

journal_volume

42

pub_type

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