Laparoscopic Partial Hepatectomy for Multiple Necrotic Nodules

Abstract

A solitary necrotic nodule is a rare benign lesion, and multiple such nodules may be present. A 71-year-old woman was referred to our hospital for follow-up after partial mastectomy for breast cancer that she underwent 12 years earlier. She had no recurrence after radiation therapy, chemotherapy, and endocrine therapy. Computed tomography (CT) showed hepatic lesions with a maximum diameter of 10 mm located in segments II, III, V, VI, and VIII. Ultrasound examination showed hypoechoic regions with distinct borders. PET-CT showed no FDG uptake in these regions, and they all had a similar morphology. A percutaneous liver biopsy showed only coagulative necrosis. Since the possibility of metastatic liver cancer could not be ruled out, laparoscopic partial hepatectomy was performed. Histopathological examination showed a solitary necrotic nodule in the liver. All intrahepatic lesions had the same morphology and were diagnosed as multiple liver necrotic nodules. There has been no sign of enlargement of the other lesions to date, four months after the surgery. In cases of multiple hepatic solitary necrotic nodules, differentiation from metastasis is extremely difficult. Laparoscopic hepatectomy was useful for the definitive diagnosis of multiple intrahepatic space occupying lesions.