Liver and intrahepatic bile ducts - Tumor

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Liver and intrahepatic bile ducts - Tumor

Benign tumors

Fatty change

Reviewers: Deepali Jain, M.D. (see Reviewers page)
Revised: 9 January 2013, last major update February 2012
Copyright: (c) 2004-2013, PathologyOutlines.com, Inc.

General
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● Also called focal fatty change
● Focal fatty change first described in 1980 (Gastroenterology 1980;78:247)

Clinical description
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● Rare, often incidental finding at autopsy or misinterpreted on imaging as neoplastic growth
● Ill-defined, single or multiple
● Simulates lipomatous tumor or malignancy (Przegl Lek 2006;63:695)
● Associated with obesity, diabetes, alcohol abuse, dyslipidemia, malnutrition, steroids, chemotherapeutic agents, AIDS
● Hepatic enzymes may be normal or mildly abnormal
● Stable or regresses if underlying condition improves
● Unknown cause; may be due to focal tissue hypoxia or local effects of insulin (Pathol Int 2008;58:59)
● Treatment directed against underlying disorder

Case reports
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● 42 year old woman with possible hepatic adenomas (Case of Week #141)

Gross description
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● Subcapsular, unencapsulate, yellow-white foci, often multiple, up to 10 cm

Gross images
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Various images

Micro description
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● Diffuse or focal steatosis adjacent to unremarkable liver, no compression of perinodular liver tissue
● Prominent blood vessels within and at the margin of the nodule
● May have foreign-body type granulomatous inflammation

Micro images
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Various images

Differential diagnosis
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● Angiomyolipoma: smooth muscle and vascular components present, positive for melanocytic markers
● Coelomic fat ectopia (Arch Pathol Lab Med 1985;109:783)
● Diffuse steatosis: not a focal mass lesion
● Focal nodular hyperplasia: nodular, but not a fatty tumor; has hepatocyte nodules surrounded by fibrous septa with large malformed arterial branches
● Hepatic adenoma: neoplastic hepatocytes
● Lipoma: well-circumscribed mass, often encapsulated, no trapped hepatocytes
● Myelolipoma: features of lipoma plus adrenal gland elements
● Foci of hepatocellular carcinoma may have fatty change also (AJR Am J Roentgenol 1988;151:717)

End of Liver and intrahepatic bile ducts-nontumor > Benign tumors > Fatty change

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