Focal nodular hyperplasia of the liver: an emerging complication of hematopoietic SCT in children

Abstract

Hepatic focal nodular hyperplasia (FNH) is a nonmalignant condition rarely affecting children previously treated for cancer, especially those who received hematopoietic SCT (HSCT). Some aspects of its pathogenesis still remain unclear and a strong association with specific risk factors has not yet been identified. We report here a single institution's case series of 17 patients who underwent HSCT and were diagnosed with FNH, analyzing retrospectively their clinical features and the radiological appearance of their hepatic lesions. We aimed to compare the diagnostic accuracy of ultrasound (US) and magnetic resonance imaging (MRI) and to explore the role of transient elastography (FibroScan) to evaluate the degree of hepatic fibrosis in FNH patients. Our analysis showed an association of FNH with age at transplant ⩽ 12 years (hazard ratio (HR) 9.10); chronic GVHD (HR 2.99); hormonereplacement therapy (HR 4.02) and abdominal radiotherapy (HR 4.37). MRI proved to be a more accurate diagnostic tool compared with US. Nine out of 12 patients who underwent FibroScan showed hepatic fibrosis. Our study points out that FNH is an emerging complication of HSCT, which requires a lifelong surveillance to follow its course in cancer patients.

Contrast-enhanced ultrasound for multiple liver lesions after bone marrow transplant in a child with leukaemia: Multifocal focal nodular hyperplasia

“…Multiple FNH have been described by Pillon et al on MRI. 13 They found a significantly higher incidence of FNH in children who underwent HSCT compared to the overall paediatric population (5.2% versus 0.02%). Majority (11/17) of the children had multiple nodules with a median of two nodules/patient (range 1-7).…”

A Novel Secondary Neoplasm Following Allogeneic Hematopoietic Stem Cell Transplant: Mixed Donor-Recipient Primitive Mesenchymal Proliferation of the Liver

“…Unlike this case, the majority of such lesions, including focal nodular hyperplasia, contain hyperplastic hepatic tissue. 5 , 6 Potential contributing causes include iatrogenic damage, GVHD-mediated inflammation, or immunosuppression.…”

Hepatic focal nodular hyperplasia after pediatric hematopoietic stem cell transplantation: The impact of hormonal replacement therapy and iron overload

“…[4][5][6][7][8][9][10][11][12] The largest series specifically dealing with patients treated with HSCT due to malignant or nonmalignant disorders include 10-17 patients each. [5][6][7]13 We hereby report 12 additional patients in this specific setting and provide a detailed analysis of the potential treatment-related risk factors for FNH.…”