GPR: 2021 - Week 37

From MGH Learn Pathology

Clinical history

38 yo M with chronic, nonlocalized abdominal pain


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Focal nodular hyperplasia
  • Usually a subcapsular, unencapsulated, well-circumscribed, bulging, tan, nodular mass.

~ 20% are multiple Firm to rubbery cut surface that bulges from surface of liver

  • Most measure less than 5 cm in diameter, but larger lesions occur.
  • Surrounding liver is normal (noncirrhotic).
  • Most characteristic finding is the presence of a central stellate scar with radiating fibrous septa that subdivide the mass into multiple smaller nodules. The central scar may be inconspicuous in smaller lesions.
  • Hemorrhage, necrosis, and bile staining are rare. 



Hepatocellular carcinoma, fibrolamellar variant

  • Lobular growth pattern and central scar
  • Can be seen in both focal nodular hyperplasia and fibrolamellar carcinoma
  • Variable hemorrhage and necrosis, can be bile-stained
  • Solitary and or satellite nodules, or multiple discrete tumors
  • Multiple small, indistinct tumor nodules can mimic cirrhosis imaging and gross examination (cirrhosis-like variant)



Metastatic well differentiated neuroendocrine tumor

  • Liver is a common site of well-differentiated neuroendocrine tumor metastasis
  • Small, yellow tumors
  • Solid, round to oval
  • Can be polypoid, ulcerated



Hepatic adenoma

  • Unencapsulated, well-defined mass
  • Can be solitary or multiple
  • Bright yellow cut surface
  • May have hemorrhage or necrosis
  • Dr. Angela Shih
  • Jessica Houston

This week's Gross Pathology Roundup was presented by Melanie Kwan MD on 2021-09-13.