Liver capsule retraction adjacent to a circumscribed liver lesion: review of 26 cases with histological confirmation

To review the histological features of 26 circumscribed liver lesions associated with liver capsule retraction and discuss the differential diagnosis while evaluating for the presence of fibrous stromal reaction. Materials and methods. Retrospective study performed between January 2005 and June 2008 including 26 patients: 18 males and 6 females, without history of cancer, aged between 42 and 82 years (mean age: 64.5 years), presenting with liver capsule retraction adjacent to a circumscribed liver lesion detected on CT or MRI. A single lesion was present in 17 patients, and multiple lesions were present in 9 patients. All liver lesions were biopsied with semi-quantitative evaluation of fibrous stromal reaction. Twenty-one patients had benign or malignant liver tumors and 5 patients had confluent hepatic fibrosis. Twenty of 21 liver tumors were malignant (95.2%): 3 intra-hepatic cholangiocarcinoma, 17 cases of metastatic disease including colorectal carcinoma (n=8), bronchogenic carcinoma (n=1), pancreatic carcinoma (n=4), esophageal carcinoma (n=1), breast carcinoma (n=1), gallbladder carcinoma (1) and endocrine neoplasm of the pancreas (n=1), and 1 case of liver sclerosing angioma (n=1). There was no case of hepatoma. Excluding the 5 cases of confluent hepatic fibrosis, fibrous stromal reaction was present in 15 of 21 cases. The presence of capsular retraction next to a circumscribed liver lesion, while non-specific, is suspicious. In keeping with previous reports, metastases were frequently the cause and intrahepatic cholangiocarcinoma was the most frequent primary tumor. In patients with chronic hepatocellular disease, confluent fibrosis was a frequent etiology. The fibrous component of the underlying malignant lesion along with its subcapsular location appear to be determining factors in the development of capsular retraction.