Hepatic Lipoma: Radiological Imaging Findings

doi:10.4236/ss.2011.27079

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Surgical Science, 2011, 2, 363-365

doi:10.4236/ss.2011.27079 Published Online September 2011 (http://www.SciRP.org/journal/ss)

Hepatic Lipoma: Radiological Imaging Findings

Mustafa Koplay1, Alper Hacioglu2, Mustafa Cem Algin2

1Departme nt of Radiolo gy, Selcuklu Medical Faculty, Selcuk University, Konya, Turkey

2Department of General Surgery, Medical Faculty, Dumlupinar University, Kutahya, Turkey

E-mail: [email protected]

Received November 26, 2010; revised March 21, 2011; accepted August 17, 2011

Abstract

Hemangiomas and hepatic metastases are the leading reasons of echogenic masses on ultrasound (US)

evaluation of the liver. Lipomas of the liver are extremely rare and have been sporadically reported in the

literature during the last century. The present report describes a patient with hepatic lipoma together with

liver metastases from gastric adenocarcinoma. A 54 years old woman was refered to our department because

of abdominal pain. Patient has been operated for gastric adenocarcinoma 3 months ago she was evaluated

with US, computed tomography (CT) and magnetic resonance imaging (MRI).The abdominal US revealed a

12 × 10 mm echogenic mass with smooth borders in 7th segment of the liver. CT scan showed a hypodense

lesion in the same hepatic segment with fat dencity and no contrast involvement. MRI demonstrated the

same lesion on T1 and T2 weighted images as hyperintence mass. The final radiographic diagnosis was he-

patic lipoma. However, there was metastas in the liver of patient. Patient died 4 months later due to metas-

tatic gastric adenocarcinoma. Hepatic lipoma should be kept in mind in echogenic masses on US evaluation

of the liver.

Keywords: Lipoma, Liver, Different Diagnosis

1. Introduction

Although ultrasound (US) is the most used imaging mo-

dality in screaning of the focal liver lesions nowadays,

the US may not characterize the nodules indwelled in

liver and computed tomography (CT) scan, MRI and/or

needle biopsy may be required for differential diagnosis

[1]. Hemangiomas and hepatic metastases are the leading

reasons of echogenic mass on ultrasonographic evalua-

tion of the liver [2]. Hepatic lipomas appear as hypere-

choic masses on ultrasonographic evaluation. The etiol-

ogy of these lesions is not well defined and their clinical

manifestations vary a lot, but often they are asympto-

matic.

We report a case of patient with hepatic lipoma and

discuss the radiographic findings. Also we discuss dif-

ferential diagnosis of the hepatic lipoma.

2. Case Report

A 54 years old woman was refered to our department

because of mass in upper-outer quadrant of the right

breast and abdominal pain. Patient has been operated for

gastric adenocarcinoma 3 months ago and has been sub-

jected to total gastrectomy, esophagojejunostomy and

Braun anastomosis. Patient have moderate to severe

symptoms of bile reflux esophagitis and abdominal dis-

comfort and ascites. Tru-cut biopsy was performed on

breast mass and histopathologic examination was not

able to make differential diagnosis between primary

breast ductal carcinoma and metastatic gastric adenocar-

cinoma, but the primary breast tumor is eventual diagno-

sis. Quadrantectomy and axillar disection was planned,

but due to comorbid problems the operation was sus-

pended. The tumor staging examinations was performed.

The abdominal US revealed a 40 × 30 mm hypoechoic

mass in 5th segment and a 12 × 10 mm echogenic mass

in 7th segment of the liver [Figure 1]. It showed also

abdominal ascites. Due to metastatic suspicion an ab-

dominal CT scan was performed. CT scan demonstrated

a metastasis compatible hypodense mass with periferal

contrast involvement (50 HU) in 5th segment and hypo-

dense mass at fat density (−80 HU) with no contrast in-

volvement in 7th segment of the liver [Figure 2]. For

futher evaluation an abdominal MRI was performed. T1

and T2 weighted images showed hyperintence lesion in

the 7th segment of the liver [Figure 3]. The final radio-

logical diagnosis was hepatic lipoma according to CT

364 M. KOPLAY ET AL.

Figure 1. US image shows the echogenic lesion in 7th seg-

ment of the liver (arrow).

Figure 2. CT axial image shows the hypodense lesion at fat

density (–80 HU) in the liver (arrow) and perihepatic as-

cites.

Figure 3. In MRI, T1 axial (a) and T2 coronal (b) weighted

images shows hyperintence lesion in liver (arrows).

and MRI findings.

During these examinations the physical condition of

the patient was gradually deteriorated and she died 4

months later.

3. Discussion

Hemangiomas and hepatic metastases are the leading

reasons of echogenic masses on ultrasonographic evalua-

tion of the liver. Hemangiomas are the most common

benign hepatic tumors and usually are below 3 cm in

diameter. Metastases are the most common malignant

tumors of the liver and generally are hypoechogenic, but

some gastrointestinal metastasis may appear echogenic.

If so, they are multiple and have periferal hypo or anech-

oic halo [2].

Hepatic lesions may contain macroscopic fat or intra-

cellular lipids. Macroscopic fat containing lesions of the

liver are angiomyolipoma, lipoma, liposarcoma, thera-

toma, pseudolipoma of the Glisson’s capsule, inrahepatic

pericaval fat, extramedullary hematopoiesis and metas-

tases. Lesions containing intracellular lipids are focal

steatosis, adenoma, focal nodular hyperplasia, regenera-

tive nodules and hepatocellular carcinoma [1,3].

Fat usually appears hyperechoic at US, although fat in

some regions may appear hypoechoic [4]. Fat attenuates

sound more than the adjacent liver parenchyma, so par-

tial acoustic shadowing may occur deep to fatty tumors.

Fat is of low attenuation (hypodense) compared with

normal liver parenchyma at computed tomography (CT),

with a range of –10 to –100 HU, and high in signal in-

tensity (hyperintence) on T1-weighted magnetic reso-

nance (MR) images [5]. In addition, several MR imaging

sequences aid in the detection of fat, including fat sup-

pression sequences (hypointence) and chemical shift im-

aging with opposed-phase gradient-echo sequences [6,7].

There are two masses with different imaging proper-

ties in the present case. One of them is compatible with

gastric cancer metastasis and the second is compatible

with hepatic lipoma, therefore both do not require sur-

gery.

Although some hepatic lipomas may mimick angiomi-

olipomas [8,9], they don’t carry malignant potential and

there are many characteristic findings on US, CT and

MRI, which are satisfactory evidences for hepatic lipoma

diagnosis. Therefore many authors do not recommend

more aggressive diagnostic procedures, such as needle

liver biopsy and operation [10]. We also believe that

awareness from characteristic imaging findings of he-

patic lipoma may prevent redundant invasive procedures.

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