Giant hyperplasia of the caudate lobe in a patient with liver cirrhosis: case report and literature review

Abstract

The caudate lobe often exhibits enlargement and nodularity in cases of cirrhosis, which makes differentiation of hepatocellular carcinoma from other mass-like lesions of the caudate lobe difficult in cirrhotic patients. A 12x6 cm mass-like enlargement of the caudate lobe was incidentally found by computed tomography in a 38-year-old man suffering from alcoholic liver cirrhosis. Magnetic resonance imaging, liver colloidal scan, and sonoguided liver biopsy were used for the differential diagnosis. A literature review revealed two case reports, all of which (like ours) presented with an enlarged caudate lobe supplied with blood via a branch of the portal vein. Therefore, in cases of giant hyperplasia of the caudate lobe, confirmation of the caudate lobe blood supply and the enhancement pattern might be important for the differentiation.

Keywords: Caudate lobe; Cirrhosis; Giant hyperplasia.

Fig. 1

(A) Postcontrast CT (arterial phase) shows large, low attenuated mass (12×6 cm sized) in the caudate lobe (arrow). It shows no arterial enhancement. (B) Postcontrast CT (portal phase) shows that the mass like lesion of caudate lobe dose not contained a portal branch. (C) Coronal T2 weighted magnetic resonance image shows isointensity of the caudate lobe. (D) T1 weighted magnetic resonance image shows hyperintensity of the caudate lobe.

Fig. 2

Technetium-tin colloid scintigram shows that normal uptake of the enlarged caudate lobe (arrow) and shows same colloid uptake level compared with normal parenchyma.

Fig. 3

(A) Histological examination of ultrasound guided liver biopsy shows micronodular cirrhosis (Masson-trichrome stain, ×100). (B) It shows that mild macrovesicular fatty metamorphosis and many bile pigments with piecemeal necrosis (H&E stain, ×400).