Focal Nodular Hyperplasia-like Lesions in Heavy Drinkers

Kondo, Fukuo

doi:10.2169/internalmedicine.48.2052

Cited by 12 publications

(13 citation statements)

References 11 publications

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“…If these criteria are strictly applied, the lesion cannot be definitively diagnosed as I-HCA and is inevitably classified as an SAA-positive nodule present in a liver with alcoholic cirrhosis. In addition, nodular lesions in heavy drinkers have been reported to show characteristics resembling those of FNH [31,32]. In this respect, the diagnosis as HCA in this lesion contradicts with the past reports [31,32].…”

Section: Usefulness and Problems Of The New Who Classificationmentioning

confidence: 65%

Pathological Diagnosis of Benign Hepatocellular Nodular Lesions Based on the New World Health Organization Classification

Kondo¹,

Fukusato²,

Kudo³

2014

Oncology

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There are various types of benign hepatocellular nodular lesions, and their diagnostic criteria were formulated in detail. However, in 2010, the new World Health Organization (WHO) classification introduced immunohistochemical diagnostic criteria for hepatocellular adenoma (HCA) reflecting molecular pathological properties, and HCA was classified into 4 subtypes. These criteria were useful for its differential diagnosis from focal nodular hyperplasia (FNH). They were also useful for the diagnosis of HCA, its subtyping, and differentiation from FNH in Japan. However, the new WHO classification is based on principles that differ from those of conventional definitions of disease concepts and methods for the differential diagnosis. Therefore, it has caused disagreements in the diagnosis in some cases. Based on this background, we present a new perspective on the diagnosis of benign hepatocellular nodular lesions.

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Section: Usefulness and Problems Of The New Who Classificationmentioning

confidence: 65%

Pathological Diagnosis of Benign Hepatocellular Nodular Lesions Based on the New World Health Organization Classification

Kondo¹,

Fukusato²,

Kudo³

2014

Oncology

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“…Unless clinicians and pathologists are aware of the aspects of this disease, they tend to misdiagnose it as HCC. The lesion is characteristically an FNH‐like one, simply found in the liver of heavy drinkers …”

Section: Discussionmentioning

confidence: 99%

“…Alcohol abuse in some cases gives rise to hyperplastic nodules such as FNH‐like nodules that are usually associated with hypervascularity . The nodules show hypervascularity and/or a tumor stain on angiography resembling the imaging findings of hepatocellular carcinoma (HCC).…”

Section: Introductionmentioning

confidence: 99%

Serum amyloid A and C‐reactive protein positive nodule in alcoholic liver cirrhosis, hard to make definite diagnosis

Kim

Kondo

Otono

et al. 2013

Hepatology Research

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We describe a case of serum amyloid A (SAA) and C-reactive protein (CRP) positive nodule detected by immunohistochemical analysis in a 37-year-old woman with alcohol-related cirrhosis. Imaging studies at first admission pointed to hepatocellular carcinoma (HCC), a dysplastic nodule, an inflammatory pseudotumor or focal nodular hyperplasia (FNH). Ultrasonography-guided biopsy in Segment 2 showed minimal atypical changes, except for a slight increase in cell density and micronodular cirrhosis in the non-nodular portion. gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging carried out after a year and a half revealed hypervascularity in the arterial phase and isointensity in the hepatobiliary phase. Three years thereafter, however, the imaging displayed a change from isointensity to a defect in the hepatobiliary phase, and the nodule demonstrated minimal histological atypia. Immunohistochemical staining of the nodule was positive for SAA, CRP, liver fatty acid-binding protein and glutamine synthetase, but negative for β-catenin, heat shock protein 70 and Glypican 3. Organic anion transporter (OATP)8 staining was weaker in the nodule than in the non-nodular portion of the alcohol-related micronodular cirrhosis. The nodule was diagnosed as an SAA and CRP positive nodule, and HCC was ruled out. Despite the change from isointensity to a defect in the hepatobiliary phase, no evidence of HCC was found in the biopsy specimen. The change may be explained more by the weak OATP8 staining compared with that of alcohol-related liver cirrhosis than by malignant transformation into HCC.

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“…It has been suggested that the artery-dominant condition derived from disturbed portal circulation in the cirrhotic liver (10) or the congenital vascular anomaly (11,12) causes localized hyperplastic changes of the hepatocytes, and generates nodular lesions such as FNH. The increased unpaired arteries, diffuse capillarization, and iron deposits in the nodule would be attributable to a similar mechanism in nodular formation.…”

Section: Discussionmentioning

confidence: 99%

Focal Nodular Hyperplasia-Like Nodule with Reduced Expression of Organic Anion Transporter 1B3 in Alcoholic Liver Cirrhosis

et al. 2011

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We report a patient with alcoholic liver cirrhosis who had a 15 mm focal nodular hyperplasia (FNH)-like nodule in the liver. This FNH-like nodule was diagnosed as hepatocellular carcinoma (HCC) mainly based on hypervascularity during the hepatic arterial phase, washout pattern during the equilibrium phase and low signal intensity during the hepatobiliary phase in gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI; it was surgically resected. Its histology exhibited hepatocyte hyperplasia, fibrous septa containing unpaired small arteries accompanied by reactive bile ductules, remarkable iron deposits and sinusoidal capillarization, and was compatible with the diagnosis of an FNH-like nodule. When we analyzed the images of the present nodule retrospectively, low signal intensity on in-phase and isosignal intensity on opposed-phase T1-weighted MRI may have reflected iron deposits in the FNH-like nodule. In addition, a low signal intensity on T2-weighted MRI and no detection in diffusion-weighted MRI may help in distinguishing FNH-like nodules from HCC, since these image findings are inconsistent with typical HCC. Immunohistochemical analysis revealed a markedly reduced expression of organic anion transporter (OATP) 1B3 in this nodule, which implied decreased Gd-EOB-DTPA uptake by hepatocytes and accounted for the low signal intensity during the hepatobiliary phase on Gd-EOB-DTPA-enhanced MRI. To the best of our knowledge this is the first report in which an FNH-like nodule was assessed for OATP1B3 expression.

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Focal Nodular Hyperplasia-like Lesions in Heavy Drinkers

Cited by 12 publications

References 11 publications

Pathological Diagnosis of Benign Hepatocellular Nodular Lesions Based on the New World Health Organization Classification

Pathological Diagnosis of Benign Hepatocellular Nodular Lesions Based on the New World Health Organization Classification

Serum amyloid A and C‐reactive protein positive nodule in alcoholic liver cirrhosis, hard to make definite diagnosis

Focal Nodular Hyperplasia-Like Nodule with Reduced Expression of Organic Anion Transporter 1B3 in Alcoholic Liver Cirrhosis

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