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August 26, 2019

Image challenge: A rare case of liver tumor

What caused an undefined liver mass to develop in a patient that has no abdominal symptom and the physical examination was unremarkable?

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Gastroenterology clinical image challenge: A 42-year-old man was referred to our hospital with a diagnosis of an undefined liver mass. The tumor continued to increase in size over the last two years based on ultrasound scans. The patient had no abdominal symptom and the physical examination was unremarkable. Hepatitis B and C tests were negative. Hepatic function tests revealed that aminotransferases, γ-glutamyl transferase, and bilirubin were normal. The carcinoembryonic antigen was 1.77 ng/mL (normal range, 0–5 ng/mL), and the alpha-fetoprotein was 3.38 ng/mL (normal range, 0–20 ng/mL).


An abdominal ultrasound examination revealed fatty infiltration in the liver (echogenicity of the liver was diffusely increased) and a homogeneous hypoechoic nodule in the right lobe with the largest measurement at 4.0 × 3.5 cm (figure). A contrast-enhanced ultrasound examination using sulphur hexafluoride showed the lesion with hypervascularity in arterial phase (figure) and washout in the portal venous and late phase (figure). Abdominal magnetic resonance imaging revealed a well-defined lesion in segment 7 showing T1 hypointensity (figure) and T2 hyperintensity (figure) with restricted diffusion on diffusion-weighted imaging (figure). On gadoxetic acid–enhanced magnetic resonance imaging, the lesion showed heterogeneous hyperenhancement in the arterial phase (figure) and persisted into the portal phase (figure). In the hepatospecifc phase, the lesion had low signal intensity compared with the surrounding liver parenchyma (figure).


What is the diagnosis?


To find out the diagnosis, read the full case in Gastroenterology.


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