Hypervascular liver nodules in heavy drinkers of alcohol

Three cases of hypervascular nodules in the liver, without hepatitis B or C virus infection and with a history of alcohol abuse (120 ml/day for 15 to 30 years), are presented.

Ultrasound examination revealed hypoechoic nodules in segment 6 (2 cm in diameter, case 1), in the right and left lobes (1-2 cm multiple type, case 2), and in segment 4 (4 cm, case 3). Hepatic angiography and computed tomography during arteriography revealed hypervascular nodules in the three cases. First, hepatocellular carcinoma, focal nodular hyperplasia, hemangioma, hemangioendothelioma, inflammatory pseudotumor, and pseudolymphoma were diagnostically differentiated. Histologically, there was no evidence of hepatocellular carcinoma or of any of the pathologies considered in the differential diagnosis by imaging studies. In case 1, the lesion was composed of an irregular, thin, trabecular-patterned hepatic acinus with slighter hypercellularity than in the nonnodular area. In cases 2 and 3, the lesions were composed mainly of fibrosis without hyperplasia, showing stellate scar-like fibrosis septa dividing the nodule. Marked pericellular fibrosis, neutrophilic infiltration, and Mallory bodies in the cytoplasm were also observed. In cases 1 and 2, small unpaired arteries explaining the hypervascularity of the nodules were observed.

These hypervascular nodules were classified as regenerative, not neoplastic, nodules according to the classification of the International Working Party.