Diagnosis and treatment for solitary necrotic nodule of the liver: report of 10 patients / 中华普通外科杂志

ABSTRACT

ObjectiveTo investigate the clinical features,therapeutic approach and prognosis of solitary necrotic nodule of the liver (SNN).MethodsClinical data of 10 SNN patients confirmed by operative pathology were analyzed retrospectively.ResultsSolitary necrotic nodule of the liver was found mainly in males (70.0％,7/10),with a median age of 47 years,most of the patients (80.0％,8/10) have no significant clinical symptoms,no underlying hepatitis.Tumor markers including CA19-9,a-fetoprotein and CEA were within normal range.Nine patients had solitary nodule and 1 patient had multiple nodules.Seven lesions located in left lobe and 4 lesions in right lobe.The diameter of the nodules was 2.9 cm ± 1.1 cm.The lesions were low or iso-intense in T1-weighted MR image,low or slight high intense in T2-weighted MR image.Contrast-enhanced MR imaging showed that internal part of lesions had no enhancement,while the capsule of the lesions demonstrated enhancement.MRI image had high diagnostic accuracy rate of 66.7％.A preoperative liver biopsy was difficult to achieve a definite diagnosis.On microscopic examination,all nodules had a central necrotic core,surrounded by fibrotic cells,inflammatory cells and multinucleated giant cells.Furthermore,among them 5 patients have fatty degeneration of the liver.All patients underwent liver resection with no recurrence within 6 - 67 months of follow up.ConclusionsThe etiology of solitary necrotic nodule is unclear.Misdiagnosis was common due to the low incidence and insufficient recognition among physicians,if a definite diagnosis can be obtained,clinical observation is recommended,and the prognosis is good.