Solitary necrotic nodule of the liver: different pathological findings express a different histogenesis

Abstract

Solitary necrotic nodule of the liver is a rare benign lesion the histogenesis of which is still debated. We here report the case of a patient who underwent laparoscopic cholecystectomy for gallstones and who was accidentally found to have a solitary necrotic nodule of 2 cm in the fifth segment of the liver. On the basis of the histological findings, the hypothesis that different pathogenetic mechanisms could be involved in the histogenesis of this lesion is discussed.

Keywords: Histogenesis; Liver tumor; Metastases; Solitary necrotic nodule.

Fig. 1

a Nodule with a completely necrotic core, with calcifications, delimited by a fibrotic capsule. HE staining, overall magnification 50×. b At higher power, granulomatous tissue is evident between the fibrous capsule and the necrotic tissue, consisting of eosinophil granular matter, calcifications, cholesterol, foam cells, and some inflammatory cells. HE staining, overall magnification 200×. c Presence of elastic fibers in the capsule, but not in the central necrotic core. Shikata's orcein staining, overall magnification 100×. d Central necrotic core showing collapse of reticular fibers. Gomori's silver staining, overall magnification 100×.

Fig. 2

a Large feeding vessels at the periphery of the lesion. The central core was more fibrous than necrotic. HE staining, overall magnification 50×. b Circularly running elastic fibers suggesting the presence of sclerotic vessels. Shikata's orcein staining, overall magnification 100×. c CD34 immunostaining evidencing small vascular lumina. Overall magnification 200×. d Gomori's silver staining evidenced some reticular fibers around the vascular lumina. No collapse of the reticular network. Overall magnification 100×.