Management of focal nodular hyperplasia and hepatocellular adenoma in young women: A series of 41 patients with clinical, radiological, and pathological correlations

Abstract

Preoperative distinction between focal nodular hyperplasia (FNH) that should be managed conservatively and hepatocellular adenoma (HA) that should be resected remains difficult. The result is controversial management of these patients. The aims of this study were to report the value of modern imaging procedures for noninvasive diagnosis of these lesions, to assess the value of intraoperative frozen section studies, and to propose a management strategy in those patients. Forty-one consecutive women with FNH (35 cases) or HA (6 cases) treated at our institution between 1985 and 1992 were studied. New imaging techniques, including enhanced magnetic resonance imaging (MRI) and color Doppler ultrasonography (US), were prospectively appraised in addition to usual techniques. Histological examination of surgical specimens was obtained in all cases. A sixfold increase in the number of patients with FNH was observed during this study, whereas the number of patients with HA did not change. FNHs were incidental US findings in 74% of the cases. The best imaging procedure in the diagnosis of FNH was enhanced MRI with a sensitivity of 70% and a specificity of 98%. Color Doppler US was a useful adjunct. Intraoperative frozen section studies were performed in 16 patients with 19 tumors with a sensitivity of 89% and a specificity of 100%.(ABSTRACT TRUNCATED AT 250 WORDS)

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

“…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%).…”

Liver cell adenoma showing sequential alteration of radiological findings suggestive of well-differentiated hepatocellular carcinoma

“…A typical LCA in MRI shows almost the same signal intensity as the surrounding parenchyma on T1 and T2 and shows high intensity on fat suppression T2. LCA may often present difficulties in a differential diagnosis with well-differentiated HCC and focal nodular hyperplasia [12][13][14] . The pathological findings of a typical LCA include the following [2,10,[15][16][17] : (1) the tumor consists of hepatocytes with almost normal nuclei and cytoplasm presenting a homogenous increase, (2) and does not include the portal area and bile duct, (3) hepatocytes form hepatic cords, but sinusoids are pressed, and hepatic lobule structure is absent, (4) the tumor includes macrovesicular fatty changes, hemorrhage, degeneration, and myogenic arteries.…”

Massive hemorrhage and infarction complicating focal nodular hyperplasia of the liver

“…Classically, FNH occurs in an otherwise normal liver and forms a multinodular nonencapsulated mass with pushing margins and a central ®brous scar that contains numerous blood vessels sprouting from a central feeding vessel [4,8]. Variants include a multifocal distribution, which occurs in 20% of cases [5,6]. Examples with a typical microscopic morphology but without a grossly evident central scar are another variation.…”

“…By contrast, FNH has an inconstant correlation with OCs, and hemorrhagic complications are reportedly rare [1,2]. Expectant management has therefore been recommended when the diagnosis is certain [5,6].…”

“…Ruptured focal nodular hyperplasia and FNH are the commonest of these lesions [1,5,9]. With combined used of clinical presentation, ultrasound, CT scan, and nuclear scintigraphy (i.e.…”