Should Focal Nodular Hyperplasia Still be Operated Upon? Analysis of a Case Series

Abstract

Background: Focal nodular hyperplasia (FNH) is a frequent benign liver lesion. Its course is considered benign, and there is no recommendation for its treatment. Nevertheless, the literature presents a high incidence of surgery. Aim: To evaluate the results of conservative treatment in a series of patients with presumed FNH. Methods: The study included patients diagnosed with FNH from May 2007 to July 2017 based on conventional imaging or magnetic resonance imaging with liver-specific contrast (MRI-LSC) or lesion biopsy (histology/immunohistochemical analysis). Patients were followed clinically and using imaging exams. Results: In a total of 54 patients, the diagnosis was obtained by typical findings on computed tomography scan and gadolinium MRI in 48.1% of the patients, by MRI-LSC in 31.5%, and by histological examination in 20.4% of cases. The mean follow-up time was 35.5 months. The initially asymptomatic patients remained symptom-free, and none of those with HNF-related pain had to worsen of the initial symptom. Conservative treatment was effective in 94.4% of the cases. In only 3 cases, there was a need for some therapeutic approach (5.5%); 2 cases for pain and 1 case for lesion growth during follow-up. Conclusion: The present study suggests that it is safe to conservatively manage patients with FNH presumed by highly accurate imaging tests. Similar to hepatic hemangiomas, surgery for FNH should be an exception.

Prominent Pseudoacini in Focal Nodular Hyperplasia

“…FNH is benign with no malignant potential, hence resection is not necessary. However, some patients do undergo resection or other interventions because of symptoms, marked enlargement, or an uncertain diagnosis 1–4…”

“…However, some patients do undergo resection or other interventions because of symptoms, marked enlargement, or an uncertain diagnosis. [1][2][3][4] Histopathologic features of classic FNH include well-demarcated nonencapsulated lesion composed of benign-appearing hepatocytes separated by fibrous septa radiating from a central scar containing large dystrophic arteries. The fibrous septa often contain lymphomononuclear infiltrate and ductular reaction, but no true bile ducts.…”

Focal nodular hyperplasia mimicking hepatocellular adenoma and carcinoma in two cases

“…In the case 1, abdominal pain alleviated after resection of this lesion, indicating that his abdominal symptoms might originate from FNH. Certainly, abdominal pain could also be attributed to other comorbidities (13), such as dyspepsia (14). In the case 2, abdominal pain remained after surgery.…”