Reactive lymphoid hyperplasia of the liver: A case report featuring characteristic nodular and perinodular enhancement
A 53-year-old female with primary biliary cholangitis was referred for the evaluation of a hepatic nodule identified during routine imaging. Ultrasonography revealed a homogeneous, hypoechoic, 18 mm nodule in segment 3 of the liver. On dynamic CT and MRI, the nodule showed mild enhancement at the he...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-05-01
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| Series: | Radiology Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1930043324001201 |
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| author | Hirohito Osanai, MD Kazuto Kozaka, MD, PhD Norihide Yoneda, MD, PhD Kotaro Yoshida, MD, PhD Azusa Kitao, MD, PhD Toshifumi Gabata, MD, PhD Kenichi Harada, MD, PhD Isamu Makino, MD, PhD Satoshi Kobayashi, MD, PhD |
| author_facet | Hirohito Osanai, MD Kazuto Kozaka, MD, PhD Norihide Yoneda, MD, PhD Kotaro Yoshida, MD, PhD Azusa Kitao, MD, PhD Toshifumi Gabata, MD, PhD Kenichi Harada, MD, PhD Isamu Makino, MD, PhD Satoshi Kobayashi, MD, PhD |
| author_sort | Hirohito Osanai, MD |
| collection | DOAJ |
| description | A 53-year-old female with primary biliary cholangitis was referred for the evaluation of a hepatic nodule identified during routine imaging. Ultrasonography revealed a homogeneous, hypoechoic, 18 mm nodule in segment 3 of the liver. On dynamic CT and MRI, the nodule showed mild enhancement at the hepatic artery-dominant phase. On diffusion-weighted images, the nodule exhibited pronounced hyperintensity with accompanying wedge-shaped perinodular hyperintensity (comet and comet-tail appearance). The nodule showed a portal perfusion defect on CT during arterial portography, and mild enhancement on CT during hepatic arteriography (CTHA). A nodular and wedge-shaped perinodular enhancement (comet and comet-tail appearance) in the CTHA was also clearly observed. The nodule demonstrated abnormal FDG uptake on 18F-FDG-PET/CT. An excisional biopsy was performed for histopathological diagnosis, and the nodule was diagnosed as reactive lymphoid hyperplasia (RLH). Diagnosing hepatic RLH by imaging is challenging due to its imaging findings overlapping with those of various malignant tumors, especially the nodular type of lymphomas, making differentiation particularly difficult. However, radiologists should note the perinodular early enhancement and the perinodular hyperintensity on diffusion weighted images, which are thought to be key imaging findings of RLH, along with other characteristics such as a single, small, homogeneous nodule with mild early enhancement and marked restricted diffusion. We propose to name the nodular lesion with perinodular early enhancement/hyperintensity on diffusion weighted images as 'comet and comet-tail appearances'. |
| first_indexed | 2024-03-07T19:09:43Z |
| format | Article |
| id | doaj.art-c988090edcc9495d8e896c0256778023 |
| institution | Directory Open Access Journal |
| issn | 1930-0433 |
| language | English |
| last_indexed | 2024-04-25T01:12:57Z |
| publishDate | 2024-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Radiology Case Reports |
| spelling | doaj.art-c988090edcc9495d8e896c02567780232024-03-10T05:11:57ZengElsevierRadiology Case Reports1930-04332024-05-0119519982003Reactive lymphoid hyperplasia of the liver: A case report featuring characteristic nodular and perinodular enhancementHirohito Osanai, MD0Kazuto Kozaka, MD, PhD1Norihide Yoneda, MD, PhD2Kotaro Yoshida, MD, PhD3Azusa Kitao, MD, PhD4Toshifumi Gabata, MD, PhD5Kenichi Harada, MD, PhD6Isamu Makino, MD, PhD7Satoshi Kobayashi, MD, PhD8Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, JapanDepartment of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan; Corresponding author.Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, JapanDepartment of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, JapanDepartment of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, JapanDepartment of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, JapanDepartment of Pathology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, JapanDepartment of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, JapanDepartment of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, JapanA 53-year-old female with primary biliary cholangitis was referred for the evaluation of a hepatic nodule identified during routine imaging. Ultrasonography revealed a homogeneous, hypoechoic, 18 mm nodule in segment 3 of the liver. On dynamic CT and MRI, the nodule showed mild enhancement at the hepatic artery-dominant phase. On diffusion-weighted images, the nodule exhibited pronounced hyperintensity with accompanying wedge-shaped perinodular hyperintensity (comet and comet-tail appearance). The nodule showed a portal perfusion defect on CT during arterial portography, and mild enhancement on CT during hepatic arteriography (CTHA). A nodular and wedge-shaped perinodular enhancement (comet and comet-tail appearance) in the CTHA was also clearly observed. The nodule demonstrated abnormal FDG uptake on 18F-FDG-PET/CT. An excisional biopsy was performed for histopathological diagnosis, and the nodule was diagnosed as reactive lymphoid hyperplasia (RLH). Diagnosing hepatic RLH by imaging is challenging due to its imaging findings overlapping with those of various malignant tumors, especially the nodular type of lymphomas, making differentiation particularly difficult. However, radiologists should note the perinodular early enhancement and the perinodular hyperintensity on diffusion weighted images, which are thought to be key imaging findings of RLH, along with other characteristics such as a single, small, homogeneous nodule with mild early enhancement and marked restricted diffusion. We propose to name the nodular lesion with perinodular early enhancement/hyperintensity on diffusion weighted images as 'comet and comet-tail appearances'.http://www.sciencedirect.com/science/article/pii/S1930043324001201Reactive lymphoid hyperplasiaPseudolymphomaPerinodular enhancementComet and comet-tail appearance |
| spellingShingle | Hirohito Osanai, MD Kazuto Kozaka, MD, PhD Norihide Yoneda, MD, PhD Kotaro Yoshida, MD, PhD Azusa Kitao, MD, PhD Toshifumi Gabata, MD, PhD Kenichi Harada, MD, PhD Isamu Makino, MD, PhD Satoshi Kobayashi, MD, PhD Reactive lymphoid hyperplasia of the liver: A case report featuring characteristic nodular and perinodular enhancement Radiology Case Reports Reactive lymphoid hyperplasia Pseudolymphoma Perinodular enhancement Comet and comet-tail appearance |
| title | Reactive lymphoid hyperplasia of the liver: A case report featuring characteristic nodular and perinodular enhancement |
| title_full | Reactive lymphoid hyperplasia of the liver: A case report featuring characteristic nodular and perinodular enhancement |
| title_fullStr | Reactive lymphoid hyperplasia of the liver: A case report featuring characteristic nodular and perinodular enhancement |
| title_full_unstemmed | Reactive lymphoid hyperplasia of the liver: A case report featuring characteristic nodular and perinodular enhancement |
| title_short | Reactive lymphoid hyperplasia of the liver: A case report featuring characteristic nodular and perinodular enhancement |
| title_sort | reactive lymphoid hyperplasia of the liver a case report featuring characteristic nodular and perinodular enhancement |
| topic | Reactive lymphoid hyperplasia Pseudolymphoma Perinodular enhancement Comet and comet-tail appearance |
| url | http://www.sciencedirect.com/science/article/pii/S1930043324001201 |
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