Imaging characteristics of hypervascular focal nodular hyperplasia-like lesions in patients with chronic alcoholic liver disease

Figure 1 A 58-year-old man with alcoholic liver cirrhosis (patient No. 5). A and B: T1-weighted gradient-echo (GRE) magnetic resonance (MR) (A: In-phase; B: Opposed-phase) image shows a small and high-signal-intensity nodule (arrow) in the lateral segment; C: T2-weighted fast spin-echo MR imaging (MRI) shows iso-intensity nodule (arrow); D and E: Gadolinium-enhanced T1-weighted GRE MRI obtained during the arterial- and portal venous phase reveals a nodule with arterial phase hyperenhancement (arrow) and without washout (arrow); F: The superparamagnetic iron oxide (SPIO)-enhanced T2*-weighted GRE MRI shows the lesion as a low-signal intensity nodule (arrow) with SPIO uptake compared with the surrounding liver parenchyma.

Figure 2 Histopathological features of the non-nodular and nodular portions. A: Non-nodular portion showing chronic hepatitis with pericellular fibrosis and diffuse capillarization of sinusoids, likely due to alcoholic injury. Mild inflammatory activity and moderate fibrosis are observed (hematoxylin and eosin staining, × 100); B: Nodular portion displaying a hyperplastic nodule with a mild increase in cell density and pericellular fibrosis. Unpaired arteries (arrow) are present in the nodule. (Hematoxylin and eosin staining, × 100); C: Non-nodular portion highlighting pericellular fibrosis and sinusoidal capillarization (Masson trichrome staining, × 100); D: Nodular portion illustrating pericellular fibrosis and unpaired arteries (arrow) within the hyperplastic nodule (Masson trichrome staining, × 100).

Figure 3 A 65-year-old man with alcoholic liver cirrhosis (patient No. 8). A and B: T1-weighted gradient-echo (GRE) magnetic resonance (MR) (A: In-phase; B: Opposed-phase) image shows a small and high-signal-intensity nodule (arrow) in segment 7 of the liver; C: Pre-contrast T1-weighted GRE MR imaging (MRI) shows iso-slightly high-intensity nodule (arrow); D and E: Gadoxetic acid-enhanced T1-weighted GRE MRI obtained during the arterial-and portal venous phase reveal a nodule with arterial phase hyperenhancement (arrow) and without washout (arrow); F: The hepatobiliary phase of the gadoxetic acid-enhanced T1-weighted GRE MRI shows homogeneous high-intense uptake (arrow); G: T2*-weighted GRE MRI shows iso-intensity nodule (arrow); H: The superparamagnetic iron oxide (SPIO)-enhanced T2*-weighted GRE MRI shows the lesion as a low-signal intensity nodule (arrow) with SPIO uptake compared with the surrounding liver parenchyma.

Figure 4 Histopathological and Immunohistochemical features of the non-nodular and nodular portions (A, C: Non-nodular, B, D, E: Nodular). A and B: Cell density, iron deposits, and sinusoidal capillarization in the surrounding liver tissue and the focal nodular hyperplasia (FNH)-like nodule. The FNH-like nodule shows increased cell density (A: hematoxylin and eosin staining × 400); C and D: OATP8 (red-orange color) is expressed on the cellular membrane of hepatocytes at the sinusoidal side. The expression of OATP8 is nearly absent in the nodule (B: × 400); however, it is diffusely found in the surrounding tissue (C: × 400). OATP8 is immunohistochemically detected using anti-OATP8; E: Immunohistochemical staining of CD68 antigen showing Kupffer cells. The staining of nodule CD68 antigen shows diffuse Kupffer cell infiltration.