[Pseudotumor nodules of the liver in cirrhotic patients. Study of 7 cases]

Hepatocellular pseudotumor (HCP) occurs in cirrhotic liver and can resemble hepatocellular carcinoma. Liver ultrasonography shows a space-occupying lesion. The aim of this study was to describe the clinical, radiological and histologic features of HCP based on seven patients (3 women, 4 men), mean age 48 years (24 to 62), with histologically proven cirrhosis (alcoholic, 4 cases; autoimmune, 1 case; postnecrotic, 1 case, idiopathic, 1 case). Serum alphafetoprotein was below 16 ng/ml in 5 patients and remained over 120 ng/ml in the remaining 2. Desgammacarboxyprothrombin, performed in 3 cases, was below the upper limit of normal range. Real time ultrasonography of the liver showed a homogeneous parenchyma in 1 case and median size (20-48 mm) space-occupying nodular lesions in 6 cases. Sonography patterns of hepatocellular pseudotumor were as follows: anechoic lesions in 5 cases and mixed pattern (sonodense and hypoechogenic) in 1 case. Angiographic findings exhibited different patterns: hypervascular or hypovascular nodules, multinodular uptake after lipiodol bolus injection. Computed tomography showed iso- or hypodense space-occupying lesions. Lipiodol injection, performed in 3 cases, showed nodular lipiodol uptake. Fine needle biopsy always showed normal hepatocytes. At laparotomy, performed in 3 cases, an hyperplastic nodule was found in 1 case only. All patients were alive at 12 to 36 months. These findings are consistent with the fact that hepatocellular pseudotumor is a true entity. Differential diagnosis is difficult. Iodine oil nodular fixation on CT scan may be non specific for hepatocellular pseudotumor. Histologic data is mandatory before beginning a non surgical therapeutic regimen for suspected hepatocellular carcinoma.