Abstract
Hepatic caseous necrotic nodules mimic metastatic liver tumors on imaging modalities. A 72-year-old man with a past history of intractable pneumonia at 50 years old was admitted to our hospital for suspicion of colonic cancer. A CT scan and MRI findings showed an ascending colonic tumor associated with regional lymph node swelling and multiple liver masses, diagnosed as multiple metastatic liver tumors. Intraoperative rapid pathology showed early colonic cancer and old caseous lymphadenitis. Excisional biopsy of a liver tumor also showed caseous necrosis encircled by hyalinized fibrous tissue, suggesting old hepatic tuberculoma. A postoperative examination did not show any evidence of either tuberculosis infection or other infections, such as atypical mycobacterium, fungus, and syphilis. Differentiating hepatic caseous necrotic nodules from metastatic liver tumors or hepatobiliary malignancies is difficult without a biopsy or extirpated specimens of hepatic nodules. Differential diagnosis of hepatic caseous necrotic nodules by intraoperative rapid pathology is essential, especially for patients who are planning to have surgery and have gastrointestinal malignancies, hepatic nodules, and a history suggesting intractable respiratory infection.
