The pathogenesis of focal nodular hyperplasia of the liver

Wanless, Ian R.

doi:10.1111/j.1440-1746.2004.03699.x

Cited by 34 publications

(54 citation statements)

References 14 publications

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“…Focal nodular hyperplasia (FNH) is an uncommon benign neoplasm with an incidence of 1-3%, usually discovered in young women, that seems to develop as a hyperplastic response to a localized vascular abnormality [29].…”

Section: Focal Nodular Hyperplasiamentioning

confidence: 99%

Characterization of focal liver lesions with contrast-enhanced ultrasound

2003

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IntroductionConventional ultrasound (US) is the preferred imaging technique used to screen for focal liver lesions (FLLs) because of its noninvasiveness and accuracy. However, it has a low specificity rate for characterization of these lesions, and therefore other imaging techniques like dynamic computed tomography (CT) or magnetic resonance imaging (MRI) are usually required. The limitations of CT and MRI are well known: both increase the cost and time of diagnosis, CT is associated with radiations problems, the intravenous contrast medium used for CT scans can be dangerous for patients with renal failure or iodinate contrast allergy, and the presence of certain biomedical implants and devices may pose hazards for patients undergoing MRI procedures. Thus, it would be advantageous if a correct diagnosis could be reached immediately during the US study. Recent advances in US technology including the availability of US contrast agents and the development of nonlinear specific contrast imaging methods have led to US imaging playing a bigger role in the characterization of FLLs, with an accuracy similar to that of dynamic CT and MRI. Contrast-specific imaging with ultrasoundContrast agents are based on gas microbubbles stabilized with different substances. When injected intravenously, microbubbles pass through the pulmonary bed and not only increase the Doppler signal but also produce enhancement of the gray-scale echostructure using specific imaging sequences [1]. Microbubbles interact with the ultrasound beam depending on the insonation energy. At very low acoustic powers [i.e., low mechanical index (MI)], they reflect ultrasound thereby increasing the echoes. As the acoustic power increases, the bubbles undergo nonlinear oscillation which produces harmonic signals. At higher acoustic powers, bubble disruption occurs, producing a strong but transient effect that may be seen as an intense signal [2]. Therefore, specific software systems capable of canceling fundamental linear components and highlighting the nonlinear harmonic components of the insonated structures have been introduced. Techniques such as pulse and phase inversion allow the microbubble enhancement to be evaluated in gray-scale. The initial imaging methods of displaying the microbubble signals used a high MI in order to destroy the microbubbles. However, these methods had several limitations including (a) a transient effect due to the microbubble disruption, (b) limited resolution, and (c) lack of penetration. Recently, further improvements have been made in order to achieve higher resolution, higher sensitivity, and good penetration, thus overcoming the problem of transient effect [3,4]. With the development of more stable and pressure-resistant second-generation contrast agents (e.g., SonoVue, Definity and Optison), combined with new low-MI contrast methods, very small blood vessels and tissue perfusion can be evaluated in real time [5]. Characterization of focal liver lesionsCharacterization of FLLs with conventional US is not possible in many case...

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Section: Focal Nodular Hyperplasiamentioning

confidence: 99%

Characterization of focal liver lesions with contrast-enhanced ultrasound

2003

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“…[1][2][3][4][5][6][7][8][9] The role of endogenous estrogens has been suggested because of the female predominance and peak incidence during childbearing years. 1,2 Concerning exogenous estrogens, high-dose estrogens may be associated with enhanced growth and marked vascular changes in FNH lesions, resulting in the recommendation that high-dose OCs be discontinued in patients with FNH. 14,16 However, we are not aware of any studies of the effects of the now widely used OCs containing a low estrogen dose on FNH growth or FNHassociated complications.…”

Section: Discussionmentioning

confidence: 99%

“…A localized increase in arterial blood flow produced by a vascular abnormality may be involved in the pathogenesis of FNH. [1][2][3] The natural history of FNH is still unknown, because long-term follow-up studies of histologically proven FNH have Microphotograph of the liver biopsy specimen. Hepatocytes were almost normal, but the radial arrangement of liver cell trabecula and lobular architecture is not observed.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous regression of focal nodular hyperplasia of the liver

Ohmoto

Honda

Hirokawa

et al. 2002

Journal of Gastroenterology

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Focal nodular hyperplasia (FNH) of the liver is a rare benign lesion that probably reflects a local hyperplastic response of hepatocytes to a vascular abnormality. Currently, the natural history of the disease remains largely unknown. We present a patient with FNH of the liver who was followed up for 4 years. A 22-year-old woman with a 3-year history of oral contraceptive use was referred to our hospital in September 1996 for further examination of a liver tumor. A diagnosis of FNH was made using various imaging methods, such as ultrasonography, enhanced computed tomography (CT) scanning, MR imaging, and hepatic angiography, as well as fine-needle biopsy. A decrease in the size of the lesion was observed by enhanced CT scanning during the 4-year observation period. In this patient, oral contraceptive use and its discontinuation may have influenced the natural history of FNH. The present case suggests that an accurate diagnosis is of the utmost importance, and a patient with FNH should be managed conservatively rather than by resection, because FNH has the potential for spontaneous regression with the discontinuation of oral contraceptives.

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“…Children account for only 7% of cases of this tumor, and FNH comprises only 2% of all pediatric liver tumors [10,12]. FNH is considered to be the result of a hyperplastic, rather than neoplastic, process [5], appearing to arise in response to increased blood flow due to a localized intrahepatic vascular malformation [13]. In its classic form, present in 80% of cases, FNH is a nodular lesion characterized by a central stellate scar with radiating fibrous septae arising from it [9].…”

Section: Discussionmentioning

confidence: 99%