Macro-vacuolar steatosis in a cirrhotic liver mimicking metastatic disease

Abstract

Multinodular steatosis represents a relatively uncommon manifestation of fatty liver disease (FLD). Co-morbidities such as metabolic syndrome or cirrhosis are often associated. Despite typical features of imaging (ultrasound, CT, and MRI), core biopsy sometimes remains the gold standard for diagnosis. We describe the case of a 57-year-old male patient with a long history of hepatic cirrhosis and a recent diagnosis of carcinoma of the tongue, successfully treated. Due to the occurrence of nausea, diarrhea and jaundice the patient is admitted to Our Hospital where ultrasound examination and contrast-enhanced CT are performed, showing global hypoechogenicity of the liver parenchyma with multiple hypo-attenuating lesions. To rule out metastatic lesions, contrast-enhanced CT of the thorax and cranium and gastroscopy and colonoscopy are performed, with no evidence of primary malignancy. Core biopsy reveals macro-vacuolar steatosis within a cirrhotic liver with regenerative aspects.

Keywords: Cirrhosis; Core biopsy; Metastatic disease; Multinodular steatosis.

Fig. 1

unenhanced and contrast-enhanced CT axial scans at different levels (A-C) showing multiple hypo-attenuating lesions spread throughout the liver, which appears hypertrophic with irregular margins.

Fig. 2

ultrasound transverse scans of the left lobe showing diffuse and heterogeneous hypoechogenicity of liver parenchyma.