Oral contraceptive use and focal nodular hyperplasia of the liver

Mathieu, Didier; Kobeiter, Hicham; Maison, Patrick; Rahmouni, Alain; Cherqui, Daniel; Zafrani, Élie Serge; Dhumeaux, Daniel

doi:10.1016/s0016-5085(00)70262-9

Cited by 216 publications

(113 citation statements)

References 26 publications

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“…Furthermore, pregnancy was not associated with FNH changes or complications. 5,7 Our case corroborates these findings because we did not observe a change in size of the lesion after 2 1 ⁄2 years of follow-up in our male graft recipient.…”

Section: Discussionsupporting

confidence: 87%

Successful outcome after transplantation of a donor liver with focal nodular hyperplasia

Tan

Carlo

Robinson

et al. 2001

Liver Transplantation

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Because of the increasing gap in the number of patients awaiting organ transplantation and the supply of organ donors, reevaluation of donor criteria is an important issue in clinical transplantation. It has become necessary to make maximal use of the currently available donor pool. We describe a case of successful orthotopic liver transplantation in a 57-year-old man with Laënnec's cirrhosis using a liver containing an 8-cm focal nodular hyperplasia (FNH) lesion involving segments II and III and the caudate lobe. The donor liver was procured from a 46-year-old woman declared brain dead after a subarachnoid hemorrhage. Definitive pathological diagnosis was made at laparotomy by obtaining a Tru-cut (Allegiance Health Care Inc, Toronto, Ontario, Canada) core biopsy specimen. The recipient operation was performed uneventfully except for bleeding from the biopsy site. The patient did well postoperatively and was discharged on tacrolimus, mofetil mycophenolate, and prednisone therapy. He continues to thrive 2 1 ⁄2 years posttransplantation with no change in the size of the lesion. In well-selected donors, FNH should not be a contraindication for use in transplantation. However, FNH must be differentiated from hepatocellular adenoma. Although FNH has a benign course with little propensity for bleeding and almost no malignant potential, hepatic adenoma is reported to have a 15% to 33% chance of bleeding and rupture with a well-documented potential for neoplastic degeneration, making the liver unsuitable for donation. O rgan transplantation is widely accepted as therapy for end-stage organ disease of the liver, kidney, pancreas, heart, and lung. Although many advances have been made in surgical technique and immunosuppression, significant disparity remains between the number of donor organs available and the multitude of potential recipients on waiting lists. The gap between donor availability and recipient need has grown over the last decade. 1,2 Consequently, criteria for use of organs are constantly being reassessed. Mass lesions in the liver should not be an absolute contraindication for use as a donor organ.We present a case in which a donor liver with focal nodular hyperplasia (FNH) was successfully transplanted into a recipient with end-stage alcoholic liver disease. This case emphasizes the need for maximal use of the available donor pool and shows that good postoperative outcome can be achieved despite using what would grossly appear to be a less-than-ideal organ. Case ReportA 57-year-old man presented with a 30-pound weight loss, fatigue, jaundice, and increasing abdominal girth over 6 months. He had a 40-year history of alcohol consumption. The patient admitted drinking at least 350 mL of beer daily. On physical examination, the patient was jaundiced, with spider angiomas, palmar erythema, and ascites. He was alert and oriented with no evidence of hepatic encephalopathy. His past medical history was unremarkable except for a lower gastrointestinal bleed (of unknown severity) approximately 1 year before presen...

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Section: Discussionsupporting

confidence: 87%

Successful outcome after transplantation of a donor liver with focal nodular hyperplasia

Tan

Carlo

Robinson

et al. 2001

Liver Transplantation

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“…As for the association between HrT and FNH, there is no consensus in literature, and the most recent studies do not support this hypothesis. [28][29][30][31] According to our data, HrT was a significant risk factor for the development of FNH, even if the therapy withdrawal did not modify the nodules' size and characteristics. Unlike hepatic adenomas, FNH rarely presents with symptoms due to complications.…”

Section: Resultsmentioning

confidence: 59%

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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“…While differentiating FNH from variants of HCA remains challenging, it has been suggested that the presence of contrast washout (i.e., lesion hypointensity compared to liver parenchyma) of HCC in the portal venous or transitional phase of dynamic contrast enhancement can be used to distinguish between HCC (that shows contrast uptake in the hepatobiliary phase) and FHN nodules. The majority of FNH tend to remain static in size, although FNH may increase in size on follow-up (3-11%), although oral contraceptives do not appear to stimulate FNH growth [38,39]. …”

Section: Focal Nodular Hyperplasiamentioning

confidence: 99%

“…Histologically, HCA is composed of cells resembling normal hepatocytes but lacking bile ducts, which distinguishes them from FNH [39].…”

Section: Hepatocellular Adenomamentioning

confidence: 99%

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Focal Liver Lesions

Schima

Koh

Baron

2018

IDKD Springer Series

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Oral contraceptive use and focal nodular hyperplasia of the liver

Cited by 216 publications

References 26 publications

Successful outcome after transplantation of a donor liver with focal nodular hyperplasia

Successful outcome after transplantation of a donor liver with focal nodular hyperplasia

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

Focal Liver Lesions

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