Transcript schiff_case_06 - Blackwell Publishing

Benign Liver Masses in HIV Patient
History:
41 y/o male flight attendant with h/o HIV (dx
1995) controlled on HAART which has been
evaluated for liver lesions
History of portal HTN found in 2002
secondary to PV thrombosis from recurrent
(biliary) pancreatitis and cholangitis
History of esophageal varices requiring
prophylactic banding
History
In 2002 he developed jaundice secondary
to viramune. It was subsequently stopped
At the same time, abdominal MRI showed
ill-defined liver lesion near porta hepatis
(seg 6)
Biopsy of the lesion showed fatty liver but
no malignancy
History:
Past medical history:
– Testosterone deficiency and previous use of
anabolic steroids
– Cholecystectomy
Lives with his domestic partner
Medications:
– Tenofovir, abacavir, nadalol, testosterone gel,
and escitalopram
Physical examination was remarkable for firm
liver and splenomegaly
Laboratory (2006):
WBC: 2.9
HgB: 15.7
PLT: 125K
INR: 1
TP: 7.6
Alb: 3.6
AST: 58
ALT: 59
ALP: 98
TB: 0.8
Hep B/C: neg
HIV: <48 copies
CD4: 281
AFP: 4
CA19-9: <3
Course:
In 2006 he was found to have increased
number of liver lesions with normal AFP
– Initial liver biopsy of lesion – no malignancy
– Rpt biopsy – suspicious for HCC
– Rpt liver biopsy (laparoscopic) negative for
malignancy
Course:
At this point it was decided to follow up the
patient with serial imaging every 3–6
months for progression or changes in liver
lesions
Imaging:
CT abdomen with contrast (2/2007):
– Splenomegaly, occluded portal veins with
cavernous transformation and collateral veins
– 5.0 cm dominant mass at segment 7/8 with
focal enhancing nodules in L and R lobes
Arterial phase
Delayed phase
Imaging:
MRI liver 07/08
– Splenomegaly, extensive varices, splenic vein and
SMA thrombosis
– Multiple hepatic masses, many with rapid
enhancement and washout
– Porta hepatis mass unchanged 4.4x3.2 cm
– Mass in segment 7, 7.3x5.4cm – consistent with focal
nodular hyperplasia
Imaging:
MRI liver 11/08
– Unchanged