Benign Liver Masses in HIV Patient

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

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 porta hepatis (seg 6) Biopsy of the lesion showed fatty liver but no malignancy

History: Past medical history: Lives with his domestic partner 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

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

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

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

Imaging: 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

Arterial phase

Delayed phase

Imaging: 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: MRI liver 11/08 Unchanged