Focal nodular hyperplasia of the liver: Radiologic findings

Shamsi, Kohkan; Schepper, A. De; Degryse, H; Deckers, F.

doi:10.1007/bf00201698

Cited by 118 publications

(67 citation statements)

References 25 publications

(35 reference statements)

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“…26 On CT scans, the classic FNH lesion is reported to be a homogeneous, hypoattenuated mass. This lesion (except for the central scar) is enhanced rapidly and dramatically during the arterial phase of contrast-enhanced CT. 13,18,24,25 On MRI scans, as is the case on CT scans, dense enhancement of the lesion (except for the central scar) is observed; MRI signal enhancement is observed after the injection of gadolinium. 19 -21 In contrast with FNH, fibrolamellar carcinoma may demonstrate a central scar with low signal intensity on T2-weighted images.…”

Section: Discussionmentioning

confidence: 91%

“…There is general agreement that specific imaging criteria indicate a definitive diagnosis of FNH. 3,4,[17][18][19][20][21][22][23][24][25] It is only in patients with clinical, biochemical, or imaging features that are not typical of FNH that histologic diagnosis is necessary to exclude the possibility of other diseases or, above all, a malignant tumor. 26 On CT scans, the classic FNH lesion is reported to be a homogeneous, hypoattenuated mass.…”

Section: Discussionmentioning

confidence: 99%

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Hepatic focal nodular hyperplasia in children previously treated for a solid tumor

Bouyn

Leclère

Raimondo

et al. 2003

Cancer

131

126

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BACKGROUNDThe detection of hepatic nodules, particularly in patients treated for a previous malignancy, raises a diagnostic dilemma. Focal nodular hyperplasia (FNH) of the liver is an uncommon, benign tumor in children and must be differentiated from malignant hepatic lesions. The etiology of FNH is obscure, and its pathogenesis is poorly understood. FNH may be a reaction to localized vascular abnormalities and circulatory disturbances. The goal of the current study was to identify risk factors for the occurrence of FNH in children who had received prior treatment for a malignant tumor.METHODSThe current retrospective study examined 14 cases of FNH in pediatric patients who previously had been treated for a malignancy. Diagnosis was based on clinical and radiologic findings and was proven histologically in four cases.RESULTSFNH lesions were discovered by chance during routine examination in 78% of patients. The incidence of FNH was particularly high in the current series (0.45%) compared with the incidence in the general pediatric population. High doses of alkylating agents (e.g., busulfan or melphalan), venoocclusive disease, and liver radiotherapy may be responsible for injury to the vascular endothelium and subsequent localized circulatory disturbances. FNH is characterized by the absence of complications after its detection; therefore, only close follow‐up is recommended.CONCLUSIONSFNH appears to be a late complication of an iatrogenic vascular disease in children with a history of malignancy. Cancer 2003;97:3107–13. © 2003 American Cancer Society.DOI 10.1002/cncr.11452

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Hepatic focal nodular hyperplasia in children previously treated for a solid tumor

Bouyn

Leclère

Raimondo

et al. 2003

Cancer

131

126

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“…33 There are no universally accepted radiological criteria to distinguish FNH from other liver lesions, although characteristic imaging features have been described. 34,35 US is generally the first technique that allows to detect nodules. 34,36 Color Doppler US and CEUS can be used to increase US diagnostic accuracy.…”

Section: Liver Fnh In Pediatric Transplanted Patients M Pillon Et Almentioning

confidence: 99%

“…34,35 US is generally the first technique that allows to detect nodules. 34,36 Color Doppler US and CEUS can be used to increase US diagnostic accuracy. 37 MRI has been shown to be the most accurate imaging modality (sensitivity 81.3%).…”

Section: Liver Fnh In Pediatric Transplanted Patients M Pillon Et Almentioning

confidence: 99%

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

Pillon

Carucci

Mainardi

et al. 2015

Bone Marrow Transplant

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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.

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“…It is usually more evident when the surrounding parenchyma is steatotic [59]. The central scar can be visualized in a limited percentage of cases: the reported figures range from 19% to 47% [47,60,61]. It usually appears mildly hyperechoic on B-mode scans (Fig.…”

Section: Sonographic Featuresmentioning

confidence: 99%

Diagnosis and management of hepatic focal nodular hyperplasia

Venturi

Piscaglia

Vidili

et al. 2007

Journal of Ultrasound

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Focal nodular hyperplasia (FNH) is the second most common benign tumor of the liver, after hemangioma. It is generally found incidentally and is most common in reproductive-aged women, but it also affects males and can be diagnosed at any age. Patients are rarely symptomatic, but FNH sometimes causes epigastric or right upper quadrant pain. The main clinical task is to differentiate it from other hypervascular hepatic lesions such as hepatic adenoma, hepatocellular carcinoma, or hypervascular metastases, but invasive diagnostic procedures can generally be avoided with the appropriate use of imaging techniques. Magnetic resonance (MR) imaging is more sensitive and specific than conventional ultrasonography (US) or computed tomography (CT), but Doppler US and contrast-enhanced US (CEUS) can greatly improve the accuracy in the diagnosis of FNH. Once a correct diagnosis has been made, in most cases there is no indication for surgery, and treatment includes conservative clinical follow-up in asymptomatic patients.Sommario L'iperplasia nodosa focale (FNH) è il tumore epatico benigno più frequente dopo l'angioma. E' di solito rilevata in modo occasionale, per lo più nelle donne in età fertile, anche se si può riscontrare in entrambi i sessi e ad ogni età. I soggetti portatori raramente sono sintomatici, nonostante l'FNH possa essere causa di dolore ai quadranti addominali superiori. Nella gestione dell'FNH il problema clinico principale è rappresentato dalla difficoltà di differenziarla dalle altre lesioni epatiche ipervascolarizzate, come l'adenoma, l'epatocarcinoma o le metastasi ipervascolari, tuttavia utilizzando le opportune tecniche diagnostiche è oggi possibile evitare il ricorso ad esami invasivi. La Risonanza Magnetica (RM) ha una sensibilità e una specificità superiori rispetto a quelle dell'ecografia convenzionale e della Tomografia Assiale Computerizzata (TC) per la diagnosi di FNH. L'uso dell'angioecografia perfusionale (CEUS) e dell'eco-Doppler può tuttavia aumentare in modo significativo la confidenza diagnostica

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Focal nodular hyperplasia of the liver: Radiologic findings

Cited by 118 publications

References 25 publications

Hepatic focal nodular hyperplasia in children previously treated for a solid tumor

Hepatic focal nodular hyperplasia in children previously treated for a solid tumor

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

Diagnosis and management of hepatic focal nodular hyperplasia

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