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Solitary Necrotic Nodules of the Liver: Histology and Diagnosis With CT and MRI.

Wang LX, Liu K, Lin GW, Zhai RY - Hepat Mon (2012)

Bottom Line: CT and magnetic resonance imaging (MRI) patterns were shown to be associated with SNN histology.The lesions were hypo-intensity on T2WI and the lesions of type II showed as mixed hyperintensity on T2WI.In conclusion, CT and MRI are useful tools for SNN diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Beijing Chaoyang Hospital, Capital University of Medical Sciences, Beijing, China.

ABSTRACT

Background: A solitary necrotic nodule (SNN) of the liver is an uncommon lesion, which is different from primary and metastatic liver cancers.

Objectives: To analyze the classification, CT and MR manifestation, and the pathological basis of solitary necrotic nodule of the liver (SNN) in order to evaluate CT and MRI as a diagnosing tool.

Patients and methods: This study included 29 patients with liver SNNs, out of which 14 had no clinical symptoms and were discovered by routine ultrasound examinations, six were found by computed tomography (CT) due to abdominal illness, four had ovarian tumors, and five had gastrointestinal cancer surgeries, previously. Histologically, these SNNs can be divided into three subtypes, i.e., type I, pure coagulation necrosis (14 cases); type II, coagulation necrosis mixed with liquefaction necrosis (five cases); and type III, multi-nodular fusion (10 cases). CT and magnetic resonance imaging (MRI) patterns were shown to be associated with SNN histology. All patients were treated surgically with good prognosis.

Results: CT AND MRI APPEARANCE AND CORRELATION WITH PATHOLOGY TYPES: three subtypes of lesions were hypo-density on both pre contrast and post contrast CT, 12 lesions were found the enhanced capsule and 1 lesion of multi- nodular fusion type showed septa enhancement. The lesions were hypo-intensity on T2WI and the lesions of type II showed as mixed hyperintensity on T2WI. The capsule showed delayed enhancement in all cases, and all lesions of multi- nodular fusion type showed delayed septa enhancement on MR images. 15 cases on CT were misdiagnosed and Four cases on MRI were misdiagnosed and the accuracy of CT and MRI were 48.3% and 86.2% respectively.

Conclusions: In conclusion, CT and MRI are useful tools for SNN diagnosis.

No MeSH data available.


Related in: MedlinePlus

Coagulation Necrosis Mixed With a Liquefaction Necrosis Type of Solitary Necrotic Nodules (SNN) in a 50-Year-Old Man (GE Medical System) (black arrow)(A) By transverse T1WI, the SNN is heterogeneous hypo-intensity relative to liver parenchyma at the right lobe of the liver. (B) By transverse T2WI, the SNN is slightly hyper-intense mixed with hyper-intense foci (white head arrow) relative to the liver parenchyma. Contrast-enhanced T1WI at arterial phase (C), at portal venous phase (D) and coronal contrast-enhanced T1WI at delay phase (E) shows no enhancement of the lesion except for marked peripheral capsule enhancement. (F) Histology of the SNN shows the liquefaction necrosis core surrounded by a coagulation necrosis area and infiltrating inflammatory cells (Hematoxylin-eosin stain; original magnification x100).
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fig59: Coagulation Necrosis Mixed With a Liquefaction Necrosis Type of Solitary Necrotic Nodules (SNN) in a 50-Year-Old Man (GE Medical System) (black arrow)(A) By transverse T1WI, the SNN is heterogeneous hypo-intensity relative to liver parenchyma at the right lobe of the liver. (B) By transverse T2WI, the SNN is slightly hyper-intense mixed with hyper-intense foci (white head arrow) relative to the liver parenchyma. Contrast-enhanced T1WI at arterial phase (C), at portal venous phase (D) and coronal contrast-enhanced T1WI at delay phase (E) shows no enhancement of the lesion except for marked peripheral capsule enhancement. (F) Histology of the SNN shows the liquefaction necrosis core surrounded by a coagulation necrosis area and infiltrating inflammatory cells (Hematoxylin-eosin stain; original magnification x100).

Mentions: All 29 patients had a single lesion in the liver, 23 of which were localized in the right lobe and six in the left lobe. The mean diameter was 3.0 centimeters, ranging from 1.0 to 4.7 cm. Macroscopically, the color of the nodules (lesions) was gray-yellow; and microscopically, 14 lesions were pure coagulation necrosis, five cases were mixed with liquefaction necrosis in the comparatively large nodules, and 10 lesions were multi-nodular fusions (six lesions had crack-like necrosis). All the lesions had peripheral hyaline fibrosis capsules and infiltration of lymphocytes, plasma cells, eosinophilia granulocytes, and a few leukocytes. The surrounding liver tissues had a normal appearance without cirrhosis in 28 cases, while one case showed fat-degeneration in the surrounding liver tissues. The bacteriological examination and acid-fast staining results were all negative. According to the pathology reports, these SNNs were divided into three subtypes, i.e., type I, pure coagulation necrosis (14 cases; Figure 1F); type II, coagulation necrosis mixed with liquefaction necrosis (five cases; Figure 2F); and type III, multinodular fusions (10 cases; Figure 3F).


Solitary Necrotic Nodules of the Liver: Histology and Diagnosis With CT and MRI.

Wang LX, Liu K, Lin GW, Zhai RY - Hepat Mon (2012)

Coagulation Necrosis Mixed With a Liquefaction Necrosis Type of Solitary Necrotic Nodules (SNN) in a 50-Year-Old Man (GE Medical System) (black arrow)(A) By transverse T1WI, the SNN is heterogeneous hypo-intensity relative to liver parenchyma at the right lobe of the liver. (B) By transverse T2WI, the SNN is slightly hyper-intense mixed with hyper-intense foci (white head arrow) relative to the liver parenchyma. Contrast-enhanced T1WI at arterial phase (C), at portal venous phase (D) and coronal contrast-enhanced T1WI at delay phase (E) shows no enhancement of the lesion except for marked peripheral capsule enhancement. (F) Histology of the SNN shows the liquefaction necrosis core surrounded by a coagulation necrosis area and infiltrating inflammatory cells (Hematoxylin-eosin stain; original magnification x100).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475020&req=5

fig59: Coagulation Necrosis Mixed With a Liquefaction Necrosis Type of Solitary Necrotic Nodules (SNN) in a 50-Year-Old Man (GE Medical System) (black arrow)(A) By transverse T1WI, the SNN is heterogeneous hypo-intensity relative to liver parenchyma at the right lobe of the liver. (B) By transverse T2WI, the SNN is slightly hyper-intense mixed with hyper-intense foci (white head arrow) relative to the liver parenchyma. Contrast-enhanced T1WI at arterial phase (C), at portal venous phase (D) and coronal contrast-enhanced T1WI at delay phase (E) shows no enhancement of the lesion except for marked peripheral capsule enhancement. (F) Histology of the SNN shows the liquefaction necrosis core surrounded by a coagulation necrosis area and infiltrating inflammatory cells (Hematoxylin-eosin stain; original magnification x100).
Mentions: All 29 patients had a single lesion in the liver, 23 of which were localized in the right lobe and six in the left lobe. The mean diameter was 3.0 centimeters, ranging from 1.0 to 4.7 cm. Macroscopically, the color of the nodules (lesions) was gray-yellow; and microscopically, 14 lesions were pure coagulation necrosis, five cases were mixed with liquefaction necrosis in the comparatively large nodules, and 10 lesions were multi-nodular fusions (six lesions had crack-like necrosis). All the lesions had peripheral hyaline fibrosis capsules and infiltration of lymphocytes, plasma cells, eosinophilia granulocytes, and a few leukocytes. The surrounding liver tissues had a normal appearance without cirrhosis in 28 cases, while one case showed fat-degeneration in the surrounding liver tissues. The bacteriological examination and acid-fast staining results were all negative. According to the pathology reports, these SNNs were divided into three subtypes, i.e., type I, pure coagulation necrosis (14 cases; Figure 1F); type II, coagulation necrosis mixed with liquefaction necrosis (five cases; Figure 2F); and type III, multinodular fusions (10 cases; Figure 3F).

Bottom Line: CT and magnetic resonance imaging (MRI) patterns were shown to be associated with SNN histology.The lesions were hypo-intensity on T2WI and the lesions of type II showed as mixed hyperintensity on T2WI.In conclusion, CT and MRI are useful tools for SNN diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Beijing Chaoyang Hospital, Capital University of Medical Sciences, Beijing, China.

ABSTRACT

Background: A solitary necrotic nodule (SNN) of the liver is an uncommon lesion, which is different from primary and metastatic liver cancers.

Objectives: To analyze the classification, CT and MR manifestation, and the pathological basis of solitary necrotic nodule of the liver (SNN) in order to evaluate CT and MRI as a diagnosing tool.

Patients and methods: This study included 29 patients with liver SNNs, out of which 14 had no clinical symptoms and were discovered by routine ultrasound examinations, six were found by computed tomography (CT) due to abdominal illness, four had ovarian tumors, and five had gastrointestinal cancer surgeries, previously. Histologically, these SNNs can be divided into three subtypes, i.e., type I, pure coagulation necrosis (14 cases); type II, coagulation necrosis mixed with liquefaction necrosis (five cases); and type III, multi-nodular fusion (10 cases). CT and magnetic resonance imaging (MRI) patterns were shown to be associated with SNN histology. All patients were treated surgically with good prognosis.

Results: CT AND MRI APPEARANCE AND CORRELATION WITH PATHOLOGY TYPES: three subtypes of lesions were hypo-density on both pre contrast and post contrast CT, 12 lesions were found the enhanced capsule and 1 lesion of multi- nodular fusion type showed septa enhancement. The lesions were hypo-intensity on T2WI and the lesions of type II showed as mixed hyperintensity on T2WI. The capsule showed delayed enhancement in all cases, and all lesions of multi- nodular fusion type showed delayed septa enhancement on MR images. 15 cases on CT were misdiagnosed and Four cases on MRI were misdiagnosed and the accuracy of CT and MRI were 48.3% and 86.2% respectively.

Conclusions: In conclusion, CT and MRI are useful tools for SNN diagnosis.

No MeSH data available.


Related in: MedlinePlus