Li Aitong, Ren Silu, Yang Xudan, Yang Chong, Lu Tao
University of Electronic Science and Technology Hospital, Chengdu, Sichuan, China.
Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China.
Front Oncol. 2025 Sep 4;15:1570896. doi: 10.3389/fonc.2025.1570896. eCollection 2025.
Paragangliomas (PGLs) are pheochromocytomas outside the adrenal glands, most commonly found in the retroperitoneal space, head and neck, bladder, and mediastinum. However, PGL occurring in the liver are extremely rare. We present a case of a 70-year-old woman who presented to our hospital with right upper abdominal pain, persisting for 2 years. Abdominal contrast-enhanced computed tomography (CT) revealed a 3.8 x 2.7 cm hypervascular nodule in the caudate lobe of the liver, demonstrating arterial phase hyperenhancement and portal/delayed phase washout. Magnetic resonance imaging (MRI) further demonstrated diffusion restriction and low signal intensity in the hepatobiliary phase (HBP) of the nodule. Based on these imaging features, hepatocellular carcinoma (HCC) was initially diagnosed radiologically. Surgical resection was performed, and immunohistochemical staining revealed positivity for chromogranin A (CgA), synaptophysin (Syn), and S - 100 protein, confirming the diagnosis of primary hepatic PGL (HPGL). This case highlights that hypervascular lesions with washout and HBP hypointensity may mimic HCC. Pathological verification is crucial, especially in patients without typical HCC risk factors. Although exceedingly rare, HPGL should be considered in the differential diagnosis of hypervascular hepatic nodules demonstrating typical arterial phase hyperenhancement and portal/delayed washout on CT/MRI, particularly in female patients presenting with nonspecific symptoms and lacking typical HCC risk factors such as hepatitis, alcohol abuse, or elevated tumor markers.
副神经节瘤（PGLs）是肾上腺外的嗜铬细胞瘤，最常见于腹膜后间隙、头颈部、膀胱和纵隔。然而，发生在肝脏的PGL极为罕见。我们报告一例70岁女性，因右上腹疼痛2年就诊于我院。腹部增强计算机断层扫描（CT）显示肝脏尾状叶有一个3.8×2.7 cm的高血管结节，动脉期强化明显，门静脉/延迟期廓清。磁共振成像（MRI）进一步显示该结节在肝胆期（HBP）有扩散受限和低信号强度。基于这些影像学特征，最初通过放射学诊断为肝细胞癌（HCC）。进行了手术切除，免疫组织化学染色显示嗜铬粒蛋白A（CgA）、突触素（Syn）和S - 100蛋白呈阳性，确诊为原发性肝副神经节瘤（HPGL）。该病例强调，有廓清和HBP低信号的高血管病变可能酷似HCC。病理证实至关重要，尤其是对于没有典型HCC危险因素的患者。尽管极为罕见，但在CT/MRI上表现为典型动脉期强化和门静脉/延迟期廓清的高血管性肝结节的鉴别诊断中，应考虑HPGL，特别是对于出现非特异性症状且缺乏肝炎、酗酒或肿瘤标志物升高等典型HCC危险因素的女性患者。
