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Evaluation and Follow-up of Benign Liver Masses in HIV Patient

Detailed case study of a 41-year-old male with HIV, portal hypertension, and multiple liver lesions, managed with HAART and regular monitoring to assess for malignancy progression.

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Evaluation and Follow-up of Benign Liver Masses in HIV Patient

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  1. Benign Liver Masses in HIV Patient

  2. History: 41 y/o male flight attendant with h/o HIV (dx 1995) controlled on HAART which has been evaluated for liver lesions History of portal HTN found in 2002 secondary to PV thrombosis from recurrent (biliary) pancreatitis and cholangitis History of esophageal varices requiring prophylactic banding

  3. History In 2002 he developed jaundice secondary to viramune. It was subsequently stopped At the same time, abdominal MRI showed ill-defined liver lesion near portahepatis (seg 6) Biopsy of the lesion showed fatty liver but no malignancy

  4. Past medical history: Testosterone deficiency and previous use of anabolic steroids Cholecystectomy Lives with his domestic partner Medications: Tenofovir, abacavir, nadalol, testosterone gel, and escitalopram Physical examination was remarkable for firm liver and splenomegaly History:

  5. Laboratory (2006): Hep B/C: neg HIV: <48 copies CD4: 281 AFP: 4 CA19-9: <3 • WBC: 2.9 • HgB: 15.7 • PLT: 125K • INR: 1 • TP: 7.6 • Alb: 3.6 • AST: 58 • ALT: 59 • ALP: 98 • TB: 0.8

  6. Course: • In 2006 he was found to have increased number of liver lesions with normal AFP • Initial liver biopsy of lesion – no malignancy • Rpt biopsy – suspicious for HCC • Rpt liver biopsy (laparoscopic) negative for malignancy

  7. Course: At this point it was decided to follow up the patient with serial imaging every 3–6 months for progression or changes in liver lesions

  8. CT abdomen with contrast (2/2007): Splenomegaly, occluded portal veins with cavernous transformation and collateral veins 5.0 cm dominant mass at segment 7/8 with focal enhancing nodules in L and R lobes Imaging:

  9. Arterial phase

  10. Delayed phase

  11. MRI liver 07/08 Splenomegaly, extensive varices, splenic vein and SMA thrombosis Multiple hepatic masses, many with rapid enhancement and washout Porta hepatis mass unchanged 4.4x3.2 cm Mass in segment 7, 7.3x5.4cm – consistent with focal nodular hyperplasia Imaging:

  12. MRI liver 11/08 Unchanged Imaging:

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