Solitary necrotic nodule of the liver

Abstract

Solitary necrotic nodule of the liver is a rare benign lesion; only 22 cases have been reported to date. An unsolved problem in treating these lesions involves the difficulties in differential diagnosis; specific features of necrotic nodule of the liver in preoperative examinations have not been identified. Here, we report a patient with resected solitary necrotic nodule of the liver with preoperative features shown on ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) examinations. A 48-year-old woman was referred to our hospital on December 13, 1999 because a hypoechoic lesion in Couinaud's segment VIII of the liver had been incidentally detected on US. A CT scan confirmed the presence of a round hypodense lesion, measuring 2 cm in diameter. No significant enhancement was recognized on dynamic MRI study. T1-Weighted MRI examinations demonstrated a low intensity showing a triple-layered pattern with low-iso-low intensity in the lesion, while T2-weighted images demonstrated a slightly high intensity in the lesion. These features suggested fibrous tissue. Histological examinations following partial resection of the liver revealed a solitary necrotic nodule of the liver. Combination studies, including MRI examinations, would be useful for the preoperative diagnosis of a solitary necrotic nodule of the liver.

Solitary Necrotic Nodules of the Liver: Cross-Sectional Imaging Findings and Follow-Up in Nine Patients

“…We postulate that these differences can be explained by different time points of observation in the evolution of solitary necrotic nodules. Early in their development, lesions show active inflammatory changes and angiogenesis that might be responsible for the high signal intensity on T2-weighted images [15] and the enhancement shown after contrast injection [13]. At a later stage, necrosis and devascularization can explain the different imaging appearances observed in our study [16].…”

“…Previous authors have reported high signal intensity on T2-weighted images in two patients [14,15] and arterial enhancement with cross-sectional imaging [5,14,18] and angiography [13,20]. All of our cases showed low signal intensity on T2-weighted images and lack of enhancement.…”

“…To that end, awareness and recognition of this entity have important implications for patient care to avoid errors in management. The existing knowledge of the imaging features of solitary necrotic nodule of the liver is gleaned mostly from articles describing one or two patients [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], and the only case series investigates the imaging features of solitary necrotic nodules of the liver with histopathology [4,7] or sonography only [21]. To our knowledge, no case series describing the imaging features of solitary necrotic nodules with cross-sectional imaging has been reported except an article that was recently published in the non-English-language literature [22].…”

“…The morphologic diagnosis was based on the presence of a central homogeneous eosinophilic necrotic area surrounded by a thin boundary of connective tissue [6,7,15,16].…”

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

“…In the current study, no feeding arteries or history of parasitic infections were found. It was proposed that the SNN might have resulted from trauma or an immune response, followed by self-defense to form fibrous tissues surrounding the coagulation necrosis (16)(17)(18). Furthermore, a previous study showed foci of metastatic carcinoma in SNN that was associated with gastrointestinal cancer (5), and included four cases of ovarian tumors and five cases of gastrointestinal cancer.…”