26 March 2009 - Case #141
All cases are archived on our website. To view them sorted by case number, diagnosis or category, visit our main Case of the Month page. To subscribe or unsubscribe to Case of the Month or our other email lists, click here.
This case was contributed by Dr. Julia Braza, Beth Israel Deaconess Medical Center, Boston, Massachusetts (USA).
Case #141
Clinical history:
A 42 year old woman presented with possible hepatic adenomas. A resected segment of liver measured 9 x 6 cm and showed 2 additional well circumscribed lesions measuring 2.5 and 2 cm.
Gross images:
Microscopic images:
What is your diagnosis?
Diagnosis: Nodules of focal fatty change
Discussion:
Focal fatty change was first described in 1980 (Gastroenterology 1980;78:247). It is rare and often an incidental finding identified at autopsy or with imaging studies. Lesions may be up to 12 cm, be single or multiple and may clinically simulate malignancy (Przegl Lek 2006;63:695). Microscopically, they consist of focal lipid deposits with preservation of the hepatic architecture.
The differential diagnosis includes other possible lipid rich lesions, including angiomyolipoma, coelomic fat ectopia, diffuse steatosis, focal nodular hyperplasia, hepatic adenoma, lipoma and myelolipoma (Arch Pathol Lab Med 1985;109:783). Fatty change has also been reported in hepatocellular carcinoma (AJR Am J Roentgenol 1988;151:717).
The cause of focal fatty change is unknown but suggested possibilities include focal tissue hypoxia or local effects of insulin in a case of metastatic insulinoma to the liver (Pathol Int 2008;58:59).
All cases are archived on our website. To view them sorted by case number, diagnosis or category, visit our main Case of the Month page. To subscribe or unsubscribe to Case of the Month or our other email lists, click here.
This case was contributed by Dr. Julia Braza, Beth Israel Deaconess Medical Center, Boston, Massachusetts (USA).
Website news:
(1) We have updated the Thyroid chapter, which now has 114 topics, 1175 image links and 926 reference links.
(2) We are currently finalizing the update of the Kidney-Tumor chapter. In response to your suggestions, not only we will be adding hundreds of new images and references, but we are formatting the chapters so they are easier to read.
Visit and follow our Blog to see recent updates to the website.
(1) We have updated the Thyroid chapter, which now has 114 topics, 1175 image links and 926 reference links.
(2) We are currently finalizing the update of the Kidney-Tumor chapter. In response to your suggestions, not only we will be adding hundreds of new images and references, but we are formatting the chapters so they are easier to read.
Visit and follow our Blog to see recent updates to the website.
Case #141
Clinical history:
A 42 year old woman presented with possible hepatic adenomas. A resected segment of liver measured 9 x 6 cm and showed 2 additional well circumscribed lesions measuring 2.5 and 2 cm.
Gross images:
Microscopic images:
What is your diagnosis?
Click here for diagnosis and discussion:
Diagnosis: Nodules of focal fatty change
Discussion:
Focal fatty change was first described in 1980 (Gastroenterology 1980;78:247). It is rare and often an incidental finding identified at autopsy or with imaging studies. Lesions may be up to 12 cm, be single or multiple and may clinically simulate malignancy (Przegl Lek 2006;63:695). Microscopically, they consist of focal lipid deposits with preservation of the hepatic architecture.
The differential diagnosis includes other possible lipid rich lesions, including angiomyolipoma, coelomic fat ectopia, diffuse steatosis, focal nodular hyperplasia, hepatic adenoma, lipoma and myelolipoma (Arch Pathol Lab Med 1985;109:783). Fatty change has also been reported in hepatocellular carcinoma (AJR Am J Roentgenol 1988;151:717).
The cause of focal fatty change is unknown but suggested possibilities include focal tissue hypoxia or local effects of insulin in a case of metastatic insulinoma to the liver (Pathol Int 2008;58:59).
