Korean J Gastroenterol.  2014 Oct;64(4):239-245. 10.4166/kjg.2014.64.4.239.

Two Cases of Hepatic Sinusoidal Dilatation Mimicking Hepatic Metastases

• Hyun JH
• Cho YK
• Song HJ
• Choi EK
• Hyun CL
• Kwon JM
• Kim BS
• Song BC

• KMID: 1979210
• DOI: http://doi.org/10.4166/kjg.2014.64.4.239

Abstract

Hepatic sinusoidal dilatation is a rare benign vascular disorder characterized by focal dilatation of the sinusoidal spaces. In most cases, the underlying etiology is unclear but it may be related to the impairment of venous outflow or sinusoidal infiltration by diverse causes. Diagnosing hepatic sinusoidal dilatation based soley on imaging study is not easy since there are no pathognomonic radiologic findings indicative of this condition. Recently, the authors experience two cases of hepatic sinusoidal infiltration. The first patient was a 53-year-old man detected to have multiple hepatic nodules on ultrasonography (US) during a routine medical check-up. The second patient was an 82-year-old woman with abdominal discomfort who was referred from local clinic with high suspicion of hepatic metastases on US. In both cases, CT scan demonstrated multiple nodules with rim enhancement on arterial phase that became iso-dense to adjacent liver parenchyma on delayed phase. On MRI, these nodules showed rim enhancement on arterial phase, had high signal intensity on T2 weighted images, and became iso-intense with partial defect on hepatobiliary phase. Because imaging studies could not exclude the presence of hepatic metastases, liver biopsy was performed and it demonstrated hepatic sinusoidal dilatation with well preserved reticulin fiber without any evidence of malignancy. Herein, we report two cases of idiopathic hepatic sinusoidal dilatation mimicking hepatic metastases.

Keyword

Hepatic sinusoidal dilatation; Hepatic metastases

MeSH Terms

Aged, 80 and over
Biopsy
Dilatation*
Female
Humans
Liver
Magnetic Resonance Imaging
Middle Aged
Neoplasm Metastasis*
Reticulin
Tomography, X-Ray Computed
Ultrasonography
Reticulin

Figure

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  Fig. 1. Liver dynamic CT findings of two cases; a 53-year-old man (A-C) and an 82-year-old woman (D-F). In the first case, CT scan shows multiple variable sized nodules (arrows) with rim enhancement on arterial phase (A), central enhancement (arrowheads) on portal phase (B) and isodense on delayed phase (C). In the second case, CT scan shows multiple variable sized nodules (arrows) with rim enhancement on arterial phase (D) which become isodense on portal (E) and delayed phase (F).

• 

  Fig. 2. MRI findings of two cases; a 53-year-old man (A-D) and an 82-year-old woman (E-G). Multiple variable sized nodules (black arrows) show rim enhancement on arterial phase (A, E), have iso-signal intensity on venous phase (B, F), demonstrate high signal intensity (white arrows) on T2 weighted image (C, G), and become iso-signal intense with partial defect (white arrowheads) on hepatobiliary phase (D, H).

• 

  Fig. 3. Pathologic findings of two cases. In the first case (a 53-year-old man), (A) sinusoids are dilated, which indicates hepatic sinusoidal dilatation, but malignant cells are not present (H&E, ×200). (B) Reticulin networks are well preserved without disruption, which rules out peliosis hepatis (Reticulin stain, ×200). In the second case (an 82-year-old woman), normal hepatocyte and dilated sinusoidal space are noted similar to the previous case (C: H&E, ×200; D: Reticulin stain, ×200).

Reference

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