A Case of Colorectal Liver Metastasis with Central Scar Mimicking Focal Nodular Hyperplasia

The authors report a case of colorectal liver metastasis which is one of the uncommon causes of liver tumor with central scar in a young female. Our patient presented with right upper abdominal discomfort and palpable liver mass for about 2 months. She did not have underlying disease. She had used oral contraceptive pills for 14 years. Physical examination revealed only liver span 16 centimeters (CM). Multidetector-row computed tomography demonstrated 3 masses and the largest one measured 10.7x 8.3x 7 cm in diameter with lobulated contour, hypodensity enhancing pattern, and a central scar at segment II and IVa of liver.  Magnetic resonance imaging (MRI) of the largest mass showed hyposignal intensity on T1-weighted and slightly hypersignal intensity in T2-weighted MRI. This mass also had a large central scar which was hyposignal intensity on T1-weighted and hypersignal intensity in T2-weighted MRI. Liver biopsy showed scattered infiltration of atypical epithelium with glandular formation. Immunohistochemical analysis was compatible with colorectal cancer. Colonoscopy was performed and revealed large mass at distal part of sigmoid colon. The patient was scheduled to undergo surgical operation and receive chemotherapy. To our knowledge, colorectal metastasis of liver should be considered as a cause of liver tumor with central scar.