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

4. 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

5. 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

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

9. 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

10. 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

11. Arterial phase

12. Delayed phase

13. 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

16. Imaging:
MRI liver 11/08
Unchanged