Hepatic Sarcoidosis Mimicking a Metastatic Tumor

Area of Science:

• Hepatology
• Radiology
• Pathology

Background:

• Hepatic sarcoidosis is frequently asymptomatic, complicating clinical recognition.
• Radiological features of hepatic sarcoidosis, typically hypoenhancing nodules, can mimic metastatic disease.
• Distinguishing hepatic sarcoidosis from metastatic liver tumors is crucial for appropriate patient management.

Purpose of the Study:

• To describe a challenging case of hepatic sarcoidosis.
• To illustrate the diagnostic difficulties encountered in differentiating hepatic sarcoidosis from metastatic liver tumors.
• To emphasize the importance of pathological findings in diagnosing hepatic sarcoidosis.

Main Methods:

• Case report detailing a patient with suspected hepatic sarcoidosis.
• Review of radiological findings, including contrast-enhanced computed tomography and magnetic resonance imaging (MRI).
• Pathological examination following laparoscopic lateral segment hepatectomy for definitive diagnosis.

Main Results:

• Hepatic nodules showed atypical MRI characteristics: hyperintense on T2-weighted images and early contrast enhancement.
• Diagnostic confusion arose between hepatic sarcoidosis and concurrent duodenal adenocarcinomas with liver metastases.
• Laparoscopic lateral segment hepatectomy provided the definitive pathological diagnosis.

Conclusions:

• Hepatic sarcoidosis can present with atypical imaging features, challenging differential diagnosis.
• Multimodality imaging and pathological confirmation are essential for diagnosing hepatic sarcoidosis, especially when mimicking malignancy.
• Surgical pathology remains the gold standard for confirming hepatic sarcoidosis in ambiguous cases.