A case of focal confluent hepatic fibrosis in the patient with hepatitis C virus-related liver cirrhosis: a mimic of cho
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A case of focal confluent hepatic fibrosis in the patient with hepatitis C virus‑related liver cirrhosis: a mimic of cholangiolocellular carcinoma Kumi Ozaki1 · Masaki Takeshita2 · Katsuhiko Saito3 · Hirohiko Kimura1 · Toshifumi Gabata4
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract During routine ultrasound examination, a hyperechoic mass was detected in the anterior segment of the liver in an 80-year-old woman with hepatitis C virus-related cirrhosis. Computed tomography and magnetic resonance imaging findings suggested a malignant tumor with abundant fibrous stroma, similar to cholangiolocellular carcinoma. However, subsequent partial hepatectomy revealed a mass characterized by abundant fibrosis without tumor cells, dilated blood vessels, and marginal ductular reaction. Accordingly, focal confluent fibrosis was diagnosed. Generally, the diagnosis of focal confluent fibrosis is straightforward because of its well-established imaging characteristics. However, its differentiation from a malignant tumor can occasionally be difficult because of variation in presentation depending on the amount of fibrous stroma and the degree of inflammatory cell infiltration. In the present case, diagnosis was difficult because the lesion was more localized than usual, presenting a mass-like shape, and there was obvious hyperintensity on T2-weighted imaging and ring-shaped hyperintensity on diffusion-weighted imaging. Moreover, hepatic capsular retraction was indistinct, which can be one of the key findings of focal confluent fibrosis. When a hepatic mass is associated with a fibrous lesion, focal confluent fibrosis should be considered in the differential diagnosis, even though the lesion is associated with several atypical findings. Keywords Confluent hepatic fibrosis · Cholangiolocellular carcinoma · Cholangiocellular carcinoma · Cirrhosis · Ductular reaction
Introduction Focal confluent fibrosis is commonly encountered in patients with end-stage cirrhosis, particularly in those with alcoholic cirrhosis [1–3], although it has also been described in patients with early-stage cirrhosis and cirrhosis with any etiology. Imaging findings of focal confluent fibrosis have been reported [1–4], and these established imaging characteristics facilitate its diagnosis. However, this condition can present with various findings and enhancement patterns, and * Kumi Ozaki ozakik‑[email protected] 1
Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23‑3 Matsuoka‑Shimoaizuki, Eiheiji, Fukui 910‑1193, Japan
2
Department of Surgery, Toyama City Hospital, Toyama, Japan
3
Diagnostic Pathology, Toyama City Hospital, Toyama, Japan
4
Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
it sometimes mimics the findings of malignant tumors such as intrahepatic cholangiocarcinoma including cholangiolocellular carcinoma, hepatocellular carcinoma, and metastases [1, 2, 4–7]. Here we report the case of
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