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CASE REPORT
Year : 2015  |  Volume : 4  |  Issue : 3  |  Page : 185-187

Lipoma in liver: A rare presentation


Department of Radiodiagnosis, Government General Hospital, Bhudhawarapeta, Kurnool, Andhra Pradesh, India

Date of Web Publication15-Sep-2015

Correspondence Address:
Onteddoo Joji Reddy
Department of Radiology, Government General Hospital, Bhudhawarapeta, Kurnool, Andhra Pradesh
India
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Source of Support: Nil., Conflict of Interest: None declared.


DOI: 10.4103/2277-8632.165398

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  Abstract 

Liver lipoma is an extremely rare tumor. Its nature and behavior is not well-known since available information is based mostly on the individual case reports. This report presents a case of liver lipoma mimicking malignant liver tumor. Patient was a 76-year-old female patient with 5-month history of the right upper abdominal quadrant pain. Diagnostic work-up revealed a large liver tumor mass, suspicious of malignancy. However, histopathological analysis found it to be benign lipoma. Because of extremely low incidence of liver lipoma, especially large ones, appropriate diagnostic work-up is very important for its differentiation from malignant tumors.

Keywords: Benign tumors, lipoma, liver


How to cite this article:
Reddy OJ, Gafoor JA, Suresh B, Prasad PO. Lipoma in liver: A rare presentation. J NTR Univ Health Sci 2015;4:185-7

How to cite this URL:
Reddy OJ, Gafoor JA, Suresh B, Prasad PO. Lipoma in liver: A rare presentation. J NTR Univ Health Sci [serial online] 2015 [cited 2020 Apr 6];4:185-7. Available from: http://www.jdrntruhs.org/text.asp?2015/4/3/185/165398


  Introduction Top


Benign hepatic lipomatous tumors of liver include lipoma, myelolipoma, angiomyolipoma and angiomyelolipoma.[1] Liver lipoma is an extremely rare tumor. It is believed that they are focal area of fatty change. We are reporting a rare case of Lipoma occurring in 76 year old female patient.


  Case Report Top


A 76-year-old female patient reported a 5-month history of the right upper abdominal quadrant pain and nausea. Physical examination revealed enlarged liver by 3 cm below right costal margin, without evidence of jaundice or ascites. There was no history of alcohol abuse. Laboratory tests showed normal liver function tests. Values of alpha-fetoprotein and creatinine were normal. Viral hepatitis serology findings were negative. Abdomen ultrasound (US) examination was performed and solid, homogenous, hyperechoic, well-delineated tumor mass in the right liver lobe occupying V, VI, VII hepatic segments was revealed [Figure 1]. Contrast enhanced computed tomography (CT) scan of the abdomen was performed, which confirmed tumor presenting as large, hypodense smoothly margined rounded mass with Hounsefeld units ranging from −30 to −100, size about 7 cm × 7.3 cm without enhancement [Figure 2] and radiologic signs of malignancy. Plain magnetic resonance imaging (MRI) abdomen was done with 0.3 Tesla feild strength, which shown hyperintense signals in mass lesion in both T1 and T2 weighted images, [Figure 3]a and b], which was suppressed in fat suppressed images [Figure 4] indicative of liopma. Focal biopsy followed and histopathological analysis found it to be benign liver lipoma with mature adipocytes interspersed by thin fibrovascular septa [Figure 5]; thus, excluding malignancy. With these imaging and histopathology findings, we report a rare case of lipoma in liver in our hospital.
Figure 1: Ultra sound of the abdomen shows well-defined hyperechoic mass lesion with posterior acoustic shadowing noted in the right lobe of liver

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Figure 2: Contrast enhanced computed tomography abdomen showing hypodense mass without enhancement

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Figure 3a and b: Non-contrast magnetic resonance imaging (0.3 tesla) spin echo, fast spin echo image showing hyperintense signals in mass lesion

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Figure 4: Non-contrast magnetic resonance imaging (0.3 tesla) fat suppressed coronal image showing suppression of mass lesion in liver suggestive of lipoma

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Figure 5: Histopathology showing mature adipocytes interspersed with thin fi brovascular septa without anaplastic changes suggestive of benign lipoma

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  Discussion Top


Benign hepatic lipomatous tumors may be seen in unusual cases. These include lipoma, myelolipoma, angiomyolipoma and angiomyelolipoma. Hepatic lipomatous tumors may occur in approximately 10% of cases of tuberous sclerosis and renal angiomyolipomas.[1] Liver lipoma is an extremely rare tumor. Our knowledge is based on the sporadic individual case reports.[2],[3],[4] Some of the authors have doubted about its origin, describing it as the focal area of fatty change with differentiation of previously undifferentiated mesenchymal cells to adipocytes.[5] These tumors are usually asymptomatic and have a good prognosis, without malignant alteration.[6] Most of them are diagnosed incidentally and are asymptomatic. Nevertheless, they may sometimes cause abdominal pain, depending upon their size.

Radiologically lipomas present as sharply bordered hyperechogenic masses with posterior attenuation on US. Although small hemangiomas may be confused with lipomas, hemangiomas usually show posterior acoustic reinforcement on US.[7] For hepatic lipomas, the diagnostic criteria on CT is a homogeneous image with the density of fat (−20 to −115 HU) and the increase in density on post-contrast images does not reach over 30 HU.[3] However, these density values must be calculated on the correct area to avoid partial volume averaging. Areas of positive density after administration of contrast medium present as adenomatous or angiomatous components.[2] Hepatocellular carcinoma and other tumors may sometimes include lipomatous degeneration, but CT may aid in their differential diagnosis.[2],[3]

The radiological differential diagnosis of hepatic lipomas includes hemangioma, chronic hematoma, hepatocellular carcinoma, hepatocellular adenoma, fat-containing metastatic tumor (e.g., teratoma), and focal fatty liver.[8] Radiological work-up, especially MRI and CT, increase the diagnostic accuracy of the liver lipomas.


  Acknowledgements Top


The authors would like to thank are greatful to Dr. M. Sai Kumar, Dr. M. Vijay Kumar, Dr. M. Rajanikanth, Dr. J. Sireesha and Dr. K. Sasidhar babu for expert opinion on this case.

 
  References Top

1.
Roberts JL, Fishman EK, Hartman DS, Sanders R, Goodman Z, Siegelman SS. Lipomatous tumors of the liver: Evaluation with CT and US. Radiology 1986;158:613-7.  Back to cited text no. 1
[PUBMED]    
2.
Langsteger W, Lind P, Schneider GH, Költringer P, Beham A, Eber O. Lipoma of the liver: Computed tomographic, ultrasonographic, and cytologic findings. Scand J Gastroenterol 1990;25:302-6.  Back to cited text no. 2
    
3.
Sonsuz A, Ozdemir S, Akdoğan M, Sentürk H, Ozbay G, Akin P, et al. Lipoma of the liver. Z Gastroenterol 1994;32:348-50.  Back to cited text no. 3
    
4.
Delis S, Triantopoulou C, Kyzas PA, Dervenis C. Multiple primary liver lipomas in a patient with chronic hepatitis B: A case report. Eur J Gastroenterol Hepatol 2007;19:807-9.  Back to cited text no. 4
    
5.
Okada K, Yokoyama S, Nakayama I, Tada I, Kobayashi M. An electron microscopic study of hepatic angiomyolipoma. Acta Pathol Jpn 1989;39:743-9.  Back to cited text no. 5
    
6.
Choi BY, Nguyen MH. The diagnosis and management of benign hepatic tumors. J Clin Gastroenterol 2005;39:401-12.  Back to cited text no. 6
    
7.
Bruneton JN, Kerboul P, Drouillard J, Menu Y, Normand F, Santini N. Hepatic lipomas: Ultrasound and computed tomographic findings. Gastrointest Radiol 1987;12:299-303.  Back to cited text no. 7
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8.
Basaran C, Karcaaltincaba M, Akata D, Karabulut N, Akinci D, Ozmen M, et al. Fat-containing lesions of the liver: Cross-sectional imaging findings with emphasis on MRI. AJR Am J Roentgenol 2005;184:1103-10.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]


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Abstract
Introduction
Case Report
Discussion
Acknowledgements
References
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