Hepatocellular Carcinoma Arising within Focal Nodular Hyperplasia

Haubert, Lisa; Yearsley, Martha; Bloomston, Mark

doi:10.1177/000313481007600320

Cited by 15 publications

(6 citation statements)

References 4 publications

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“…While several studies have reported co-occurrence of FNH and HCC [4][5][6]9 , to our knowledge this is the first study showing a clonal relationship between these lesions. Moreover, we found uncommon genetic alterations in the HCC that might be associated with hepatocarcinogenesis in the background underlying FNH.…”

Section: Discussionmentioning

confidence: 63%

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Genomic analysis of focal nodular hyperplasia with associated hepatocellular carcinoma unveils its malignant potential: a case report

et al. 2022

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Background Focal nodular hyperplasia (FNH) is typically considered a benign tumor of the liver without malignant potential. The co-occurrence of FNH and hepatocellular carcinoma (HCC) has been reported in rare cases. In this study we sought to investigate the clonal relationship between these lesions in a patient with FNH-HCC co-occurrence. Methods A 74-year-old female patient underwent liver tumor resection. The resected nodule was subjected to histologic analyses using hematoxylin and eosin stain and immunohistochemistry. DNA extracted from microdissected FNH and HCC regions was subjected to whole exome sequencing. Clonality analysis were performed using PyClone. Results Histologic analysis reveals that the nodule consists of an FNH and two adjoining HCC components with distinct histopathological features. Immunophenotypic characterization and genomic analyses suggest that the FNH is clonally related to the HCC components, and is composed of multiple clones at diagnosis, that are likely to have progressed to HCC through clonal selection and/or the acquisition of additional genetic events. Conclusion To the best of our knowledge, our work is the first study showing a clonal relationship between FNH and HCC. We show that FNH may possess the capability to undergo malignant transformation and to progress to HCC in very rare cases.

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Section: Discussionmentioning

confidence: 63%

“…FNH is rarely associated with HCC, however, the risk of malignant transformation from FNH to HCC has been already suggested 9 . In this study, we describe a 74-year-old female patient with an FNH and a concomitant HCC nodule in a non-cirrhotic liver.…”

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confidence: 99%

Genomic analysis of focal nodular hyperplasia with associated hepatocellular carcinoma unveils its malignant potential: a case report

et al. 2022

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“…8 37-39 The ACG guideline advices a conservative stance due to rarity of FNH-induced HCC formation or hepatic rupture. [40][41][42] However, it does not cite literature for its recommendation of follow-up of FNH in female patients using CP. The EASL guideline states there is insufficient evidence to support or refute elective surgery for FNH.…”

Section: Discussionmentioning

confidence: 99%

Scoping review of clinical practice guidelines on the management of benign liver tumours

Haring

Cuperus

Duiker

et al. 2021

BMJ Open Gastroenterol

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ObjectiveBenign liver tumours (BLT) are increasingly diagnosed as incidentalomas. Clinical implications and management vary across and within the different types of BLT. High-quality clinical practice guidelines are needed, because of the many nuances in tumour types, diagnostic modalities, and conservative and invasive management strategies. Yet, available observational evidence is subject to interpretation which may lead to practice variation. Therefore, we aimed to systematically search for available clinical practice guidelines on BLT, to critically appraise them, and to compare management recommendations.DesignA scoping review was performed within MEDLINE, EMBASE, and Web of Science. All BLT guidelines published in peer-reviewed, and English language journals were eligible for inclusion. Clinical practice guidelines on BLT were analysed, compared, and critically appraised using the Appraisal of Guidelines, Research and Evaluation (AGREE II) checklist regarding hepatic haemangioma, focal nodular hyperplasia (FNH), and hepatocellular adenoma (HCA). Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations (PRISMA) for scoping reviews were adhered to.ResultsThe literature search yielded unique 367 papers, 348 were excluded after screening of title/abstract, and 16 after full-text screening. Three guidelines were included: the American College of Gastroenterology (ACG; 2014), Brazilian Society of Hepatology (SBH; 2015), and European Association for the Study of the Liver (EASL; 2016). There was no uniformity in the assessment methods for grading and gravity of recommendations between guidelines. Among observed differences were: (1) indications for biopsy in all three tumours; (2) advices on contraceptive pills and follow-up in FNH and HCA; (3) use of an individualised approach to HCA; (4) absence of recommendations for treatment of HCA in men; and (5) approaches to HCA subtype identification on magnetic resonance imaging.ConclusionRecognising differences in recommendations can assist in harmonisation of practice standards and identify unmet needs in research. This may ultimately contribute to improved global patient care.

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“…Dysplastic changes that develop in FNH are thought to be a first step in a carcinogenic pathway. In fact, there are relatively uncommon instances where hepatocellular carcinoma developed within preexisting FNH (Davis et al 1975;Langrehr et al 2006;Petsas et al 2006;Haubert et al 2010). Fibrolamellar carcinoma has also been reported to arise in FNH (Imkie et al 2005).…”

Section: Clonality Of Fnh Fnh Dysplasia and Hepatic Malignancymentioning

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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Hepatocellular Carcinoma Arising within Focal Nodular Hyperplasia

Cited by 15 publications

References 4 publications

Genomic analysis of focal nodular hyperplasia with associated hepatocellular carcinoma unveils its malignant potential: a case report

Genomic analysis of focal nodular hyperplasia with associated hepatocellular carcinoma unveils its malignant potential: a case report

Scoping review of clinical practice guidelines on the management of benign liver tumours

Focal Nodular Hyperplasia (FNH) of the Liver

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