Rare association of solitary necrotic nodule of the liver with rheumatoid arthritis and systemic lupus erythematosus

Abstract

Solitary necrotic nodule of the liver (SNNL) is a rare benign lesion with uncertain etiology characterized by a "completely necrotic core" and a hyalinized capsule containing elastin fibers (Journal of Clinical Pathology 36:1181-1183, 1983). We report herein a 26-year-old woman with a previous diagnosis of rheumatoid arthritis, systemic lupus erythematosus, and Sjögren's syndrome and no history of malignancy who presented with a complaint of diarrhea of 1-year duration. In the abdominal ultrasound, multiple paraaortic, portocaval, and ileal lymphadenopathies (LAPs) have been found with the largest one being 2 cm in size. The biopsy of the iliac LAP showed reactive nodular hyperplasia. An abdominal CT disclosed an incidental hypoechoic, heterogenous mass sized 27 × 27 mm close to segment VI of the liver. A trucut biopsy of this lesion was made, and clinicopathologic features of the specimen were compatible with a solitary necrotic nodule of the liver. Here, we discuss the diagnosis and the clinical course of this rare entity in light of current literature.

Keywords: Solitary necrotic nodule of the liver; rheumatoid arthritis; systemic lupus erythematosus.

Figure 1

Abdominal CT showing slightly hypoechoic heterogenous solid mass in the subcapsular region of the posterior segment of the right lobe of the liver (see arrow).

Figure 2

(a) Abdominal MRI T2 showing a mass hypointense in the center and hyperintense in the periphery at segment VI of the liver. (b) Dynamic contrast MRI enterography showing the progression of this lesion 3 months after the first abdominal MRI (see arrow).

Figure 3

(a) ocalized necrotizing granulomatous lesion (HE 100×). (b) Fibrous tissue surrounding a center of fibrinoid necrosis and hyalinizing fibrotic areas of the central necrotic area (Masson’s trichrome 200×). (c) Surrounding granulomatous inflammation (HE 400×).