Hepatic segmental atrophy: a diagnostic challenge with variable clinicopathologic features and an association with cardiovascular disease

Hepatic segmental atrophy is an underrecognized pseudotumor that can cause diagnostic challenges. These lesions can be mass-forming and demonstrate a range of pathologic features that can lead to diagnostic errors on both imaging studies, on frozen section, and in biopsy material. The aim of this study was to better understand the clinicopathologic features of this condition as well as its association with cardiovascular disease. A retrospective computerized search of the files of two institutions was conducted spanning 2012 to 2024. All surgical slides were reviewed, and clinical and demographic information was collected. There were 45 patients, including 23 men and 22 women with median age of 63 years. Most (35/45, 78%) patients had a history of hypertension or cardiovascular disease. Thirty patients had a history of malignant neoplasm, and seven had cirrhosis. Histologically, the cases showed variable histologic features, ranging from nodular elastosis to more subtle lesions featuring degenerative hepatocytes with relative preservation of bile ducts between them. Association of these lesions with remote vascular injury might be explained by cardiovascular disease, most commonly hypertension. The current case series emphasizes the importance of recognizing this lesion and its association with cardiovascular diseases. While lobular or segmental atrophy of the liver has been recognized as a complication of many benign and malignant conditions, pathologists should be aware that this can present as a mass lesion.