Ruptured focal nodular hyperplasia observed during follow-up: a case report

Abstract

BackgroundFocal nodular hyperplasia (FNH) is the second most common benign hepatic tumor and is very rarely complicated by hemorrhage or rupture. Although thought to be extremely rare, there have been several reports of hemorrhage caused by ruptured FNH. Herein, we report the case of a patient with ruptured FNH, who subsequently developed hemorrhage during follow-up.Case presentationA 32-year-old man was admitted to our department for an asymptomatic hepatic tumor in segments 4 and 5 (S4/5), which measured 8 cm in diameter and observed to project from the liver. Imaging and pathologic examination of a biopsy specimen confirmed the diagnosis of FNH. Three years after the diagnosis, the patient was readmitted to our hospital because of sudden onset of upper abdominal pain. Dynamic abdominal computed tomography revealed ascites around the tumor with high-density areas that were considered to represent hematoma caused by ruptured FNH. Transcatheter arterial embolization (TAE) was performed to stop the hemorrhage. One month after TAE, S4/5 of the liver was resected; macroscopic findings revealed that a large part of the tumor was composed of necrotic tissue and hematoma. Pathological examination using hematoxylin–eosin staining and immunohistochemical examination indicated a final diagnosis of FNH rupture and hemorrhage.ConclusionAlthough a well-established diagnosis of FNH usually requires no treatment or surveillance, careful examination remains necessary when the FNH is large and projects from the liver because of the possibility of rupture and hemorrhage.

Case Report: Rare Acute Abdomen: Focal Nodular Hyperplasia With Spontaneous Rupture

“…Previous cases of FNH with intraperitoneal hemorrhage, including this patient, reported in English-language publications are shown in Table 1 ( 3 , 14 – 20 ). This review reviewed 11 patients, including 2 males and 9 females.…”

“…It is thought to be a hyperplastic response to increased blood flow in an arterial malformation rather than a true neoplasm ( 1 , 2 ). Spontaneous hemorrhage of an FNH is very rare, and only 10 cases have been reported ( 3 ). This patient with spontaneous rupture and bleeding of a FNH in the right liver was successfully treated by second step surgical treatment.…”

Focal nodular hyperplasia associated with a giant hepatocellular adenoma: A case report and review of literature

“…Close follow-up is however recommended for FNH more than 5 cm. Some authors advocate for upfront surgery with FNH larger than 5 cm[ 14 - 16 ]. However, we do not recommend a surgical resection in our daily practice but advocate for a close follow-up strategy.…”

Focal nodular hyperplasia: are the existing surgical indications sufficient?

“…Persist in so doing, we found some patients developed mental problems such as anxiety or insomnia. Some rare severe complications like acute bleeding or perforation have also been reported [7].…”