Liver adenomatosis mimics metastatic liver involvement on FDG-PET/ CT

Česká verzia

Authors: O. Bělohlávek ¹; M. Jarůšková ¹; M. Šmakal ²
Authors place of work: Oddělení nukleární medicíny – PET centrum, Nemocnice Na Homolce, Praha ¹; NH Hospital a. s., Onkologický stacionář, Hořovice ²
Published in the journal: Klin Onkol 2023; 36(2): 143-145
Category: Case Report
doi: https://doi.org/10.48095/ccko2023143

Summary

Background: Liver adenomatosis is a very rare disease. In the literature, we were able to find only two case reports documenting the appearance of this disease on PET/CT with ¹⁸F-fludeoxyglucose (FDG-PET/CT). Case: Numerous liver foci were detected during sonography in a 52-year-old female patient with uncharacteristic pain in the epigastrium without oncological history, with negative oncomarkers and without clinical signs of generalized neoplasia. Complementary MRI examination expressed the suspicion of metastatic origin of the foci, and FDG-PET/CT was indicated in order to identify the primary tumour and assess the extent of the disease. A whole-body FDG-PET/CT examination showed multiple (> 20) markedly hypermetabolic liver foci with 3–20 mm in diameter, reaching a relative accumulation of SUV_BWmax = 13, together with several ametabolic cysts; elsewhere in the scope of the examination, focally pathologically increased metabolic activity was not evident. Subsequently, the patient underwent a biopsy targeted at one of the hypermetabolic liver foci with the finding of HNF 1A inactivated variant of hepatocellular adenoma; primary or secondary malignancy was not demonstrated. Considering the histological findings and the large number of liver foci, the final diagnosis of liver adenomatosis was set. The patient remains under continuous observation. Conclusion: Adenomatous foci were markedly hypermetabolic during FDG-PET/CT examination and could not be distinguished from tumour metastases by this method. Our finding is consistent with two other observations we were able to find in the literature.

Keywords:

liver – FDG-PET/CT – adenomatosis – hepatocellular adenoma

Zdroje

1. Ranstrom S. Miliary hepatocellular adenomatosis. Acta Pathol Microbiol Scand 1953; 33 (3): 225–229.

2. Flejou JF, Barge J, Menu Y et al. Liver adenomatosis: an entity distinct from liver adenoma? Gastroenterology 1985; 89 (5): 1132–1138.

3. Chiche L, Dao T, Salamé E et al. Liver adenomatosis: reappraisal, diagnosis, and surgical management eight new cases and review of the literature. Ann Surg 2000; 231 (1): 74–81. doi: 10.1097/00000658-200001000-00011.

4. Lammert C, Toal E, Mathur K et al. Large hepatic adenomas and hepatic adenomatosis: a multicenter study of risk factors, interventions, and complications. Am J Gastroenterol 2022; 117 (7): 1089–1096. doi: 10.14309/ajg.0000000000001743.

5. Ribeiro A, Burgart LJ, Nagorney DM et al. Management of liver adenomatosis: results with a conservative surgical approach. Liver Transpl Surg 1998; 4 (5): 388–398. doi: 10.1002/lt.500040505.

6. Lucas E, Pareja E, Carvajal N et al. Hepatic adenomatosis: a disease with controversial treatment. Cir Esp 2014; 92 (4): 284–286. doi: 10.1016/j.ciresp.2013.09. 006.

7. Lee SY, Kingham TP, LaGratta MD et al. PET-avid hepatocellular adenomas: incidental findings associated with HNF1-a mutated lesions. HPB (Oxford) 2016; 18 (1): 41–48. doi: 10.1016/j.hpb.2015.07.001.

8. Young JR, Graham RP, Venkatesh SK et al. 18F-FDG PET/CT of hepatocellular adenoma subtypes and review of literature. Abdom Radiol (NY) 2021; 46 (6): 2604–2609. doi: 10.1007/s00261-021-02968-2.

9. Sanli Y, Bakir B, Kuyumcu S et al. Hepatic adenomatosis may mimic metastatic lesions of liver with 18F-FDG PET/CT. Clin Nucl Med 2012; 37 (7): 697–698. doi: 10.1097/RLU.0b013e3182443ced.

10. Öz A, Koyuncu Sökmen B, İnan N et al. Incidentally detected PET-avid liver adenomatosis: MRI and 18F-FDG PET-CT findings. Turk J Gastroenterol 2018; 29 (5): 623–624. doi: 10.5152/tjg.2018.18105.