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Case Reports
. 2020 Nov;102(9):e1-e4.
doi: 10.1308/rcsann.2020.0141. Epub 2020 Jul 31.

Diffuse liver hamartomatosis (diffuse von Meyenburg complexes) mimicking hepatic metastases on a background of previous cancer

J Monteiro de Barros  1 , D Stell  1 , T S Bracey  2 , V K Mavroeidis  1
Affiliations
Case Reports

Diffuse liver hamartomatosis (diffuse von Meyenburg complexes) mimicking hepatic metastases on a background of previous cancer

J Monteiro de Barros et al. Ann R Coll Surg Engl. 2020 Nov.

Abstract

Bile duct hamartomas are typically small benign liver lesions that can radiologically mimic metastases on ultrasound and computed tomography, as well as macroscopically. We present a rare and interesting case and review the relevant literature. A 49-year-old woman underwent ultrasound investigation for right upper quadrant pain, which revealed diffuse liver lesions. In the setting of her previous vulval cancer, it was suspected that she had hepatic metastases. This was strongly reinforced with computed tomography and elevated CA 19-9 levels. A liver biopsy revealed diffuse and multifocal bile duct hamartomas and positron emission tomography was negative for metastases or features of cancer recurrence. A diagnosis of diffuse liver hamartomatosis was made. In view of the continuing clinical and laboratory picture, she required regular follow-up. The collective features of this case are unique, as the isolated characteristics of particular interest have not been previously described in the context of a single case. Bile duct hamartomas should be included in the differential diagnosis of multiple liver lesions. CA 19-9 is not a reliable marker for differential diagnosis of this entity.

Keywords: Bile duct hamartoma; CA 19-9; Hamartomatosis; Liver metastases; von Meyenburg complexes.

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Figures

Figure 1
Figure 1
Liver ultrasound showing multiple heterogeneous nodular areas compatible with metastases
Figure 2
Figure 2
Computed tomography of the abdomen; axial section showing multiple low-attenuation liver lesions
Figure 3
Figure 3
Computed tomography of the abdomen; coronal section showing the multifocal nature of the lesions
Figure 4
Figure 4
Multiple dilated bile ductules consistent with bile duct hamartomas
See this image and copyright information in PMC

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