A 34-year-old woman is found dead in her apartment. Medical history is significant for substance use disorder and a prior hospitalization for upper extremity cellulitis. An autopsy examination is performed. A ruptured plaque in the proximal anterior descending artery with an overlying occlusive thrombus is found. Incidentally, a 4-cm hepatic mass in the right lobe of the liver is also found. The mass is lighter than the surrounding liver tissue and appears lobulated with a central, gray-white, depressed stellate scar from which fibrous septae radiate to the periphery. The rest of the liver is normal. No additional abnormalities are noted on autopsy. Which of the following is the most likely diagnosis of this patient's liver lesion?

Question

A 34-year-old woman is found dead in her apartment.  Medical history is significant for substance use disorder and a prior hospitalization for upper extremity cellulitis.  An autopsy examination is performed.  A ruptured plaque in the proximal anterior descending artery with an overlying occlusive thrombus is found.  Incidentally, a 4-cm hepatic mass in the right lobe of the liver is also found.  The mass is lighter than the surrounding liver tissue and appears lobulated with a central, gray-white, depressed stellate scar from which fibrous septae radiate to the periphery.  The rest of the liver is normal.  No additional abnormalities are noted on autopsy.  Which of the following is the most likely diagnosis of this patient's liver lesion?

Quizplus · Accepted Answer

This patient's liver mass is characteristic of focal nodular hyperplasia (FNH), a nonmalignant lesion that most commonly occurs in young women. FNH is thought to result from a hepatic vascular abnormality causing localized hyperperfusion with a secondary hyperplastic response. Classically, the lesions appear as small, solitary, pale nodules composed of cords of normal-appearing hepatocytes and a central stellate scar with fibrous septae that surround abnormally large hepatic arterial branches. FNH is benign and typically does not enlarge, undergo malignant transformation, or rupture; therefore, most cases do not require treatment. These lesions are usually asymptomatic and discovered incidentally during autopsy or abdominal imaging for a different condition. The diagnosis is confirmed most often by observing a characteristic solitary mass on imaging with features indicating the arterial origin of FNH (eg, enhancement with contrast in the arterial phase). (Choice B) Hepatic adenoma is a benign liver lesion that is strongly associated with oral contraceptive use and may undergo malignant transformation or rupture. Although it can also be discovered incidentally, a hepatic adenoma will usually appear as an irregular, tan-colored group of nodules composed of large plates of adenoma cells with an absence of normal hepatic architecture (no portal structures or bile ducts). (Choice C) Hepatic hemangioma is the most common benign hepatic tumor but would be characterized by a dark, vascular tumor with areas of hemorrhage. Histologically, these tumors display cavernous vascular compartments lined by epithelium and filled with red blood cells. (Choice D) Hepatocellular carcinoma (HCC) is a malignant liver tumor that usually develops in the setting of underlying chronic liver disease (eg, chronic viral hepatitis, alcohol-induced cirrhosis). Well-differentiated HCC can appear similar to normal liver tissue; however, these tumors are typically larger, irregular, and symptomatic (eg, abdominal pain, elevated LFTs) with areas of hemorrhage on gross examination. (Choice E) Hydatid cysts are caused by the larvae form of Echinococcus granulosus, a canine tapeworm. This pathogen is rare in the United States, and hepatic echinococcal lesions would present as fluid-filled cysts lined by a membrane derived from the parasite. Educational objective: Focal nodular hyperplasia is a benign liver tumor marked by a central stellate scar containing an abnormally large artery. It usually arises in young women and most cases are asymptomatic and found incidentally.

A 34-Year-Old Woman Is Found Dead in Her Apartment