To evaluate a hepatic nodule in a 74-year-old man with metabolic dysfunction and alcohol-related liver disease.
Approach:
Patient Evaluation: A 74-year-old man with a 5.3-cm hepatic nodule was evaluated using serologic testing, liver function tests, and imaging studies.
Imaging and Diagnosis: Dynamic contrast-enhanced MRI indicated arterial phase hyperenhancement and washout, leading to a preliminary diagnosis of hepatocellular carcinoma (HCC).
Surgical Intervention: The patient underwent laparoscopic left hemihepatectomy for diagnostic confirmation and curative intent.
Histopathological Analysis: Histopathology confirmed the diagnosis of a primary hepatic gastrointestinal stromal tumor (GIST) through immunohistochemical staining.
Key Findings:
The hepatic nodule exhibited imaging features consistent with LI-RADS 5, typically associated with HCC.
Primary hepatic GISTs are rare, with only about 40 cases reported in literature.
Interpretation:
Despite typical HCC imaging features, the diagnosis was a rare primary hepatic GIST, highlighting the need for differential diagnosis in chronic liver disease.
Limitations:
The rarity of primary hepatic GISTs may limit the generalizability of findings to broader populations.
Imaging characteristics of hepatic GISTs are not well-defined, complicating accurate diagnosis.
Conclusion:
Primary hepatic GIST should be considered in the differential diagnosis of liver nodules in patients with chronic liver disease, even when imaging suggests HCC.
