Focal nodular hyperplasia of the liver without central scar

Matsushita, Masayuki; Hajiro, Kiyoshi; Suzaki, Takeshi; Takakuwa, Hiroshi; Sawami, Hiroyasu; Kusumi, Fusako; Konishi, Yoichi; Maruo, Masayuki; Ohana, Masaya; Okano, Akihiro; Uchida, Kazushige

doi:10.1007/bf02063245

Cited by 14 publications

(5 citation statements)

References 9 publications

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“…[8][9][10] FNH is usually a solitary mass with central scar that represent thick fibrous septa with vascular/ductal proliferation and arise at the periphery of non-cirrhotic livers, although a few rare cases may lack the scar and may occur in the cirrhotic liver. [10][11][12] These features did not fit with the hilar nodules in our cases. Partial nodular transformation (PNT) that usually occurs as a solitary large nodule at the porta hepatis may simulate the hilar nodules in the present series.…”

Section: Discussioncontrasting

confidence: 69%

“…NRH are observed as diffuse multiple nodules, usually less than 1.5 cm in size 8–10 . FNH is usually a solitary mass with central scar that represent thick fibrous septa with vascular/ductal proliferation and arise at the periphery of non‐cirrhotic livers, although a few rare cases may lack the scar and may occur in the cirrhotic liver 10–12 . These features did not fit with the hilar nodules in our cases.…”

Section: Discussionmentioning

confidence: 63%

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Clinicopathological study of a hilar nodule in the livers of long‐term survivors with biliary atresia

Ijiri

Tanaka

Kato

et al. 2001

Pathology International

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With the application of liver transplantation for patients with biliary atresia (BA), we have had the opportunity to review the clinicopathologic features of the native livers from 10 transplanted BA patients. A single large nodule at porta hepatis (hilar nodule) was noted in three of 10 patients, and an ill-defined nodule-like lesion at porta hepatis was present in two other patients. The three BA patients with hilar nodules were long-term survivors, compared to the patients with nodule-like and those without nodules. The hilar nodules measured between 5.0 cm and 8.0 cm and histologically, they were partly surrounded by fibrous septa with relatively well-preserved liver architectures and fewer inflammatory cells at the portal triads when compared to the surrounding cirrhotic lesions. No nuclear or cellular atypia was observed. Proliferating cell nuclear antigen labeling index was higher in the surrounding cirrhotic lesions than the hilar nodules. The nodule-like lesions at porta hepatis also showed similar light microscopic and immunohistochemical features as the hilar nodules. These hilar nodules did not seem to contain any malignant potential. The benign histology with relatively well-preserved liver architecture and the preferential site of occurrence at porta hepatis where bile seemed to flow more smoothly, suggested possible residues of less-affected hepatic tissues.

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Section: Discussioncontrasting

confidence: 69%

Section: Discussionmentioning

confidence: 63%

Clinicopathological study of a hilar nodule in the livers of long‐term survivors with biliary atresia

Ijiri

Tanaka

Kato

et al. 2001

Pathology International

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“…15,22 Visualization of the central scar remains a challenge, and this typical feature is not constantly observed, with results ranging from 30% to 43%. 23,25,26 The absence of a central scar on imaging decreases diagnostic certainty in FNH, as observed in 24 patients in this study. Some of these cases corresponded to lesions with small-sized scars on the gross specimen and to atypical FNH without a central scar.…”

Section: Discussionmentioning

confidence: 55%

Histologic scoring of liver biopsy in focal nodular hyperplasia with atypical presentation

et al. 2002

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The contribution of radio-guided transcutaneous biopsy in the diagnosis of focal nodular hyperplasia (FNH) of the liver was compared with the findings on surgical specimens to assess its contribution in clinical and radiologic atypical cases. This retrospective study involved 30 patients with atypical tumors on imaging who underwent liver biopsy and then surgery. All surgical specimens were diagnosed as FNH, either classical (n ‫؍‬ 18) or nonclassical (n ‫؍‬ 12). Imaging data were reviewed according to 4 radiologic criteria on magnetic resonance imaging (MRI) and/or computed tomography (CT) scan (hypervascularity, homogeneity, nonencapsulation, and presence of a central scar), and classified depending on the number of criteria found (group I, 4 of 4; group II, 3 of 4; group III, 2 or fewer). Histologic assessment of ultrasound (US)-guided liver biopsy recorded major diagnostic features (fibrous bands, thick-walled vessels, reactive ductules, and nodularity) and minor features (sinusoidal dilatation and perisinusoidal fibrosis). "Definite FNH" (3 or 4 major features) was diagnosed in 14 biopsies, "possible FNH" (2 major and 1 or 2 minor features) in 7 cases, and "negative for FNH" (2 or fewer major features without minor features) in 9 cases. The diagnosis of FNH on biopsy was reached in 14 cases (58.3%) in patients with 2 or fewer imaging criteria (group III; n ‫؍‬ 24). Biopsies with a diagnosis of "possible FNH" corresponded to a large proportion of telangiectatic-type FNH on the specimen. In conclusion, liver biopsy does not appear to be necessary in cases in which imaging is typical. However, the absence of radiologic diagnostic criteria in FNH does not preclude a positive diagnosis on liver needle biopsy. Using the proposed histologic scoring system, surgical management may be avoided in these cases. (HEPATOLOGY 2002;35:414-420.) F ocal nodular hyperplasia (FNH) of the liver is a benign disorder that usually occurs in women of childbearing and middle age. Numerous terms have been used to designate this entity, 1 reflecting the different morphologic aspects and the confusion that currently exists regarding its pathogenesis, which is thought to be hyperplastic, rather than neoplastic, in nature. 2 A liver nodule with a central fibrous scar containing aberrant vessels of various size and thickness and reactive ductules surrounded by abnormal regenerative hepatocyte nodules 3 characterizes the classical form of FNH, as originally described by Edmonson. 4 A previous study on surgical specimens described nonclassical forms of this lesion: all lacking the central scar but in which parenchymal nodularity and vascular anomalies were still the main features. 5 In classical cases, the diagnosis is usually made easily using radiologic criteria either on computed tomography (CT) scan or magnetic resonance imaging (MRI). 6,7 These criteria include hypervascularity with enhancement during arterial phase, homogeneity of the lesion, nonencapsulation, and the presence of a central scar. Conservative management of FNH is curre...

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“…An enhancing scar has, overall, been reported to occur in 14-43 % of cases (Vilgrain et al 1992). There are rare examples of FNH lacking a central scar (Matsushita et al 1995). Part of FNH shows a spoke-wheel arterial pattern related to the architecture of septa originating from the central scar (Ungermann et al 2007).…”

Section: Clinical and Imaging Featuresmentioning

confidence: 99%

Focal Nodular Hyperplasia (FNH) of the Liver

Zimmermann¹

2016

Tumors and Tumor-Like Lesions of the Hepatobiliary Tract

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Focal nodular hyperplasia (FNH) of the liver is a reactive mass-forming regenerative hyperplastic response of hepatocytes, secondary to localized vascular and circulatory abnormalities. FNH has a predilection for young females and represents, after hemangioma, the second most common benign hepatic tumorous lesion of the liver in adults. Many FNH are asymptomatic and detected by chance, but a minority of FNH are associated with various symptoms mainly related to large size or atypical location. Most FNH are solitary lesions that are predominantly located in the right liver lobe. In a minority of patients, multiple lesions, sometimes exceeding 30, are present. Macroscopically, FNH are well-circumscribed nodular, yellowish to tan masses with a characteristic nodular texture, radiating septa, and a central stellate scar-like fibrotic structure. Part of the lesions protrude from the liver and can become pedunculated masses. The diameter of FNH may exceed 20 cm. Histologically, FNH is characterized by nodules that consist of normal-looking hepatocytes forming thin plates. These nodules are separated from each other by fibrous septa and interspersed portal tract-like structures. The latter lack interlobular bile ducts but contain ductular proliferations. The fibrous tissue areas contain abnormal thick-walled blood vessels.

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Focal nodular hyperplasia of the liver without central scar

Cited by 14 publications

References 9 publications

Clinicopathological study of a hilar nodule in the livers of long‐term survivors with biliary atresia

Clinicopathological study of a hilar nodule in the livers of long‐term survivors with biliary atresia

Histologic scoring of liver biopsy in focal nodular hyperplasia with atypical presentation

Focal Nodular Hyperplasia (FNH) of the Liver

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