DOI: 10.1148/rg.252045083
Fat-containing Lesions of the Liver: Radiologic-Pathologic Correlation1
Srinivasa R. Prasad, MD,
Hanlin Wang, MD, PhD,
Humberto Rosas, MD,
Christine O. Menias, MD,
Vamsi R. Narra, MD,
William D. Middleton, MD and
Jay P. Heiken, MD
1 From the Department of Radiology, University of Texas Health Science Center at San Antonio (S.R.P.); the Department of Pathology and Immunology, Washington University, St Louis, Mo (H.W.); and the Department of Radiology, Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, Ninth Floor, St Louis, MO 63110 (H.R., C.O.M., V.R.N., W.D.M., J.P.H.). Presented as an education exhibit at the 2002 RSNA Scientific Assembly. Received April 20, 2004; revision requested June 7; revision received and accepted June 30. All authors have no financial relationships to disclose.
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Figure 1. Focal hepatic steatosis. Axial US scan of the liver shows an ovoid, uniformly hyperechoic focus (arrow), a finding consistent with focal fat.
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Figure 2a. Focal hepatic steatosis. (a) Axial in-phase T1-weighted MR image shows peripheral high-signal-intensity foci (arrow). (b) Axial opposed-phase T1-weighted MR image shows a uniform decrease in the signal intensity of the foci (arrow).
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Figure 2b. Focal hepatic steatosis. (a) Axial in-phase T1-weighted MR image shows peripheral high-signal-intensity foci (arrow). (b) Axial opposed-phase T1-weighted MR image shows a uniform decrease in the signal intensity of the foci (arrow).
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Figure 3. Axial US scan shows patchy, diffuse hepatic steatosis (arrow), which simulates an infiltrative tumor.
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Figure 4a. Multinodular hepatic steatosis. (a) Axial in-phase T1-weighted GRE image shows subtle hyperintense foci (arrow). (b) Axial out-of-phase T1-weighted GRE image shows uniform signal loss in the foci (arrows).
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Figure 4b. Multinodular hepatic steatosis. (a) Axial in-phase T1-weighted GRE image shows subtle hyperintense foci (arrow). (b) Axial out-of-phase T1-weighted GRE image shows uniform signal loss in the foci (arrows).
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Figure 5. Contrast-enhanced CT scan shows a fatty hepatic pseudomass due to omental packing (arrow). Such a pseudomass is a common postoperative finding.
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Figure 6a. Hepatic adenoma. (6a) Axial in-phase T1-weighted GRE image shows a large, hypointense mass in the right hepatic lobe (arrow). (6b) Axial out-of-phase T1-weighted GRE image shows a homogeneous decrease in the signal intensity of the adenoma (arrow). (6c) Photograph of the gross pathologic specimen shows areas of hemorrhage (arrow). (6d) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows intracytoplasmic fat vacuoles (arrow) within adenoma cells.
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Figure 6b. Hepatic adenoma. (6a) Axial in-phase T1-weighted GRE image shows a large, hypointense mass in the right hepatic lobe (arrow). (6b) Axial out-of-phase T1-weighted GRE image shows a homogeneous decrease in the signal intensity of the adenoma (arrow). (6c) Photograph of the gross pathologic specimen shows areas of hemorrhage (arrow). (6d) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows intracytoplasmic fat vacuoles (arrow) within adenoma cells.
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Figure 6c. Hepatic adenoma. (6a) Axial in-phase T1-weighted GRE image shows a large, hypointense mass in the right hepatic lobe (arrow). (6b) Axial out-of-phase T1-weighted GRE image shows a homogeneous decrease in the signal intensity of the adenoma (arrow). (6c) Photograph of the gross pathologic specimen shows areas of hemorrhage (arrow). (6d) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows intracytoplasmic fat vacuoles (arrow) within adenoma cells.
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Figure 6d. Hepatic adenoma. (6a) Axial in-phase T1-weighted GRE image shows a large, hypointense mass in the right hepatic lobe (arrow). (6b) Axial out-of-phase T1-weighted GRE image shows a homogeneous decrease in the signal intensity of the adenoma (arrow). (6c) Photograph of the gross pathologic specimen shows areas of hemorrhage (arrow). (6d) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows intracytoplasmic fat vacuoles (arrow) within adenoma cells.
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Figure 7. Nonenhanced CT scan of a patient with multiple adenomas shows macroscopic fat deposition (arrow).
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Figure 8a. Focal nodular hyperplasia. (a) Axial arterial phase T1-weighted MR image shows a lobulated, well-circumscribed tumor with intense and uniform enhancement (arrow). (b) Axial opposed-phase T1-weighted GRE image shows a patchy peripheral focus of low signal intensity (arrow), which represents a focal fat deposit. (c) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows intracellular fat vacuoles (arrow).
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Figure 8b. Focal nodular hyperplasia. (a) Axial arterial phase T1-weighted MR image shows a lobulated, well-circumscribed tumor with intense and uniform enhancement (arrow). (b) Axial opposed-phase T1-weighted GRE image shows a patchy peripheral focus of low signal intensity (arrow), which represents a focal fat deposit. (c) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows intracellular fat vacuoles (arrow).
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Figure 8c. Focal nodular hyperplasia. (a) Axial arterial phase T1-weighted MR image shows a lobulated, well-circumscribed tumor with intense and uniform enhancement (arrow). (b) Axial opposed-phase T1-weighted GRE image shows a patchy peripheral focus of low signal intensity (arrow), which represents a focal fat deposit. (c) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows intracellular fat vacuoles (arrow).
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Figure 9. Axial US scan shows uniformly hyper-echoic lesions (arrow), which represent hepatic lipomas.
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Figure 10a. Hepatic angiomyolipoma. (a) Contrast-enhanced CT scan shows a well-circumscribed, heterogeneous tumor of the right lobe with foci of fat (arrow). (b) Photograph of the gross specimen shows that the tumor is large and lobulated with areas containing fat (arrow). (c) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows proliferating smooth muscle (arrow), vessels, and adipose tissue (arrowheads).
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Figure 10b. Hepatic angiomyolipoma. (a) Contrast-enhanced CT scan shows a well-circumscribed, heterogeneous tumor of the right lobe with foci of fat (arrow). (b) Photograph of the gross specimen shows that the tumor is large and lobulated with areas containing fat (arrow). (c) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows proliferating smooth muscle (arrow), vessels, and adipose tissue (arrowheads).
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Figure 10c. Hepatic angiomyolipoma. (a) Contrast-enhanced CT scan shows a well-circumscribed, heterogeneous tumor of the right lobe with foci of fat (arrow). (b) Photograph of the gross specimen shows that the tumor is large and lobulated with areas containing fat (arrow). (c) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows proliferating smooth muscle (arrow), vessels, and adipose tissue (arrowheads).
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Figure 11a. Hepatic invasion by a primarily retroperitoneal teratoma. (a) Contrast-enhanced CT scan shows a predominantly fatty mass with a peripheral rim and central chunky calcification (arrow). (b) Photograph of the gross specimen shows that the mass is cystic with solid areas and papillary fronds. (c) Photomicrograph (original magnification, x400; hematoxylin-eosin stain) of a portion of the mass shows mature adipose tissue (arrow) and blood vessels.
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Figure 11b. Hepatic invasion by a primarily retroperitoneal teratoma. (a) Contrast-enhanced CT scan shows a predominantly fatty mass with a peripheral rim and central chunky calcification (arrow). (b) Photograph of the gross specimen shows that the mass is cystic with solid areas and papillary fronds. (c) Photomicrograph (original magnification, x400; hematoxylin-eosin stain) of a portion of the mass shows mature adipose tissue (arrow) and blood vessels.
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Figure 11c. Hepatic invasion by a primarily retroperitoneal teratoma. (a) Contrast-enhanced CT scan shows a predominantly fatty mass with a peripheral rim and central chunky calcification (arrow). (b) Photograph of the gross specimen shows that the mass is cystic with solid areas and papillary fronds. (c) Photomicrograph (original magnification, x400; hematoxylin-eosin stain) of a portion of the mass shows mature adipose tissue (arrow) and blood vessels.
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Figure 12. Nonenhanced CT scan shows a heterogeneous lesion in the right lobe that contains macroscopic fat (arrow). Histopathologic analysis demonstrated a hepatic adrenal rest tumor.
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Figure 13a. Hepatocellular carcinoma. (a) CT scan shows patchy macroscopic fat deposition ( ) in a large, heterogeneously enhancing hepatoma. (b) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows fat vacuoles within tumor cells (arrow).
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Figure 13b. Hepatocellular carcinoma. (a) CT scan shows patchy macroscopic fat deposition () in a large, heterogeneously enhancing hepatoma. (b) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows fat vacuoles within tumor cells (arrow).
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Figure 14a. Hepatic liposarcoma. (a) Serial surveillance contrast-enhanced CT scan obtained after resection of an extremity liposarcoma shows a fatty hepatic metastasis (arrow). (b) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows lipoblasts with hyperchromatic nuclei (arrow) in a vascular stroma, an appearance consistent with a liposarcoma.
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Figure 14b. Hepatic liposarcoma. (a) Serial surveillance contrast-enhanced CT scan obtained after resection of an extremity liposarcoma shows a fatty hepatic metastasis (arrow). (b) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows lipoblasts with hyperchromatic nuclei (arrow) in a vascular stroma, an appearance consistent with a liposarcoma.
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Figure 15. Contrast-enhanced CT scan shows hepatic metastases containing foci of fat (arrow). The metastases were from an intestinal tumor synthesizing vasoactive intestinal peptide.
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Copyright © 2005 by the Radiological Society of North America.
