Diagnosis and treatment of hepatic focal nodular hyperplasia (Analysis of 22 cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

GAO Pengji , CHEN Lei , GAO Jie , WANG Dong , HUANG Lei , LI Shu , WANG Fushun , LENG Xisheng ,  ZHU Jiye

Beijing Key Surgical Basic Research Laboratory of Liver Cirrhosis and Liver Cancer, Peking University People’s Hospital, Beijing 100044, P.R.China;

Corresponding author：

ZHU Jiye, Email: gandanwk@vip.sina.com

Keywords：

focal nodular hyperplasia; magnetic resonance imaging; diagnosis; treatment

DOI：

10.7507/1007-9424.201703112

Video：

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Objective To summarize manifestation, imaging characteristics, and treatment of hepatic focal nodular hyperplasia (FNH). Methods From January 2007 to December 2016, the patients pathologically confirmed hepatic FNH were included in this study. The clinical features and imaging characteristics were analyzed retrospectively. Results Twenty-two cases were pathologically diagnosed as hepatic FNH with an age of (36.8±11.2) years (range from 20 to 61 years). Ten were males and 12 were females. Three patients had abdominal pain and 19 patients had no symptoms. The diameter of the lesions was (4.16±1.92) cm (range from 1.0 to 7.8 cm) and approximately 9 (40.9%) lesions were more than 5.0 cm. The diagnosis rates of CT and MRI were 64.70% (11/17) and 84.21% (16/19), respectively. All the patients underwent hepatectomy successfully and recovered without severe complications. No recurrence and metastasis happened during following-up of 1–103 months. Conclusions Hepatic FNH is more common in young patients and has no typical symptoms. MRI is useful in diagnosis of hepatic FNH.

Citation： GAO Pengji, CHEN Lei, GAO Jie, WANG Dong, HUANG Lei, LI Shu, WANG Fushun, LENG Xisheng, ZHU Jiye. Diagnosis and treatment of hepatic focal nodular hyperplasia (Analysis of 22 cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(5): 546-550. doi: 10.7507/1007-9424.201703112 Copy

1.	Edmondson HA. Tumors of the liver and intrahepatic bile ducts: Atlas of tumors pathology. Section 7. Fascicule 25. Washington DC: Armed Forces Institute of Pathology, 1958: 120.
2.	Maillette de Buy Wenniger L, Terpstra V, Beuers U. Focal nodular hyperplasia and hepatic adenoma: epidemiology and pathology. Dig Surg, 2010, 27(1): 24-31.
3.	Ohmoto K, Honda T, Hirokawa M, et al. Spontaneous regression of focal nodular hyperplasia of the liver. J Gastroenterol, 2002, 37(10): 849-853.
4.	Reddy KR, Kligerman S, Levi J, et al. Benign and solid tumors of the liver: relationship to sex, age, size of tumors, and outcome. Am Surg, 2001, 67(2): 173-178.
5.	Scalori A, Tavani A, Gallus S, et al. Oral contraceptives and the risk of focal nodular hyperplasia of the liver: a case-control study. Am J Obstet Gynecol, 2002, 186(2): 195-197.
6.	Zhuang L, Ni C, Din W, et al. Huge focal nodular hyperplasia presenting in a 6-year-old child: A case presentation. Int J Surg Case Rep, 2016, 29: 76-79.
7.	Vilgrain V. Focal nodular hyperplasia. Eur J Radiol, 2006, 58(2): 236-245.
8.	王征旭, 胡桂芳, 吴孟超. 肝脏局灶性结节性增生的诊断和治疗 (附 21 例报告). 中国普外基础与临床杂志, 2003, 10(2): 147-150.
9.	沈英皓, 樊嘉, 吴志全, 等. 肝脏局灶性结节性增生 60 例临床分析. 中华普通外科杂志, 2005, 20(7): 397-399.
10.	孟凡宇, 陈金明, 李盈. 肝脏局灶性结节性增生的临床诊治 176 例. 世界华人消化杂志, 2014, 22(28): 4333-4337.
11.	Luciani A, Kobeiter H, Maison P, et al. Focal nodular hyperplasia of the liver in men: is presentation the same in men and women? Gut, 2002, 50(6): 877-880.
12.	Kinoshita M, Takemura S, Tanaka S, et al. Ruptured focal nodular hyperplasia observed during follow-up: a case report. Surg Case Rep, 2017, 3(1): 44.
13.	Rahili A, Cai J, Trastour C, Juwid A, et al. Spontaneous rupture and hemorrhage of hepatic focal nodular hyperplasia in lobus caudatus. J Hepatobiliary Pancreat Surg, 2005, 12(2): 138-142.
14.	Becker YT, Raiford DS, Webb L, et al. Rupture and hemorrhage of hepatic focal nodular hyperplasia. Am Surg, 1995, 61(3): 210-214.
15.	Burgio MD, Ronot M, Salvaggio G, et al. Imaging of hepatic focal nodular hyperplasia: pictorial review and diagnostic strategy. Semin Ultrasound CT MR, 2016, 37(6): 511-524.
16.	Kong WT, Wang WP, Huang BJ, et al. Contrast-enhanced ultrasound in combination with color Doppler ultrasound can improve the diagnostic performance of focal nodular hyperplasia and hepatocellular adenoma. Ultrasound Med Biol, 2015, 41(4): 944-951.
17.	Zhang HT, Gao XY, Xu QS, et al. Evaluation of the characteristics of hepatic focal nodular hyperplasia: correlation between dynamic contrast-enhanced multislice computed tomography and pathological findings. Onco Targets Ther, 2016, 9: 5217-5224.
18.	Rousseau C, Ronot M, Vilgrain V, et al. Optimal visualization of focal nodular hyperplasia: quantitative and qualitative evaluation of single and multiphasic arterial phase acquisition at 1.5 T MR imaging. Abdom Radiol (NY), 2016, 41(5): 990-1000.
19.	Suh CH, Kim KW, Kim GY, et al. The diagnostic value of Gd-EOB-DTPA-MRI for the diagnosis of focal nodular hyperplasia: a systematic review and meta-analysis. Eur Radiol, 2015, 25(4): 950-960.
20.	唐艳华, 张峰, 王海屹, 等. 肝脏局灶性结节增生的不典型常规 MRI 影像表现. 中华医学杂志, 2016, 96(7): 544-546.
21.	Mamone G, Caruso S, Cortis K, et al. Complete spontaneous regression of giant focal nodular hyperplasia of the liver: Magnetic resonance imaging evaluation with hepatobiliary contrast media. World J Gastroenterol, 2016, 22(47): 10461-10464.
22.	Kudo M, Zheng RQ, Chung H, et al. Long-term follow-up of atypical progressive focal nodular hyperplasia increasing in size and number implicates its pathogenesis. Am J Gastroenterol, 2008, 103(8): 2153-2155.
23.	Sadowski DC, Lee SS, Wanless IR, et al. Progressive type of focal nodular hyperplasia characterized by multiple tumors and recurrence. Hepatology, 1995, 21(4): 970-975.
24.	Tajiri K, Tsuneyama K, Kawai K, et al. A case of progressing focal nodular hyperplasia and its molecular expression pattern. Clin J Gastroenterol, 2014, 7(3): 271-277.
25.	Hau HM, Atanasov G, Tautenhahn HM, et al. The value of liver resection for focal nodular hyperplasia: resection yes or no? Eur J Med Res, 2015, 20: 86.
26.	张建伟, 王成锋, 刘骞, 等. 肝脏局灶性结节性增生的临床诊治分析, 中华医学杂志, 2007, 87(36): 2531-2533.
27.	Perrakis A, Demir R, Müller V, et al. Management of the focal nodular hyperplasia of the liver: evaluation of the surgical treatment comparing with observation only. Am J Surg, 2012, 204(5): 689-696.

1. Edmondson HA. Tumors of the liver and intrahepatic bile ducts: Atlas of tumors pathology. Section 7. Fascicule 25. Washington DC: Armed Forces Institute of Pathology, 1958: 120.
2. Maillette de Buy Wenniger L, Terpstra V, Beuers U. Focal nodular hyperplasia and hepatic adenoma: epidemiology and pathology. Dig Surg, 2010, 27(1): 24-31.
3. Ohmoto K, Honda T, Hirokawa M, et al. Spontaneous regression of focal nodular hyperplasia of the liver. J Gastroenterol, 2002, 37(10): 849-853.
4. Reddy KR, Kligerman S, Levi J, et al. Benign and solid tumors of the liver: relationship to sex, age, size of tumors, and outcome. Am Surg, 2001, 67(2): 173-178.
5. Scalori A, Tavani A, Gallus S, et al. Oral contraceptives and the risk of focal nodular hyperplasia of the liver: a case-control study. Am J Obstet Gynecol, 2002, 186(2): 195-197.
6. Zhuang L, Ni C, Din W, et al. Huge focal nodular hyperplasia presenting in a 6-year-old child: A case presentation. Int J Surg Case Rep, 2016, 29: 76-79.
7. Vilgrain V. Focal nodular hyperplasia. Eur J Radiol, 2006, 58(2): 236-245.
8. 王征旭, 胡桂芳, 吴孟超. 肝脏局灶性结节性增生的诊断和治疗 (附 21 例报告). 中国普外基础与临床杂志, 2003, 10(2): 147-150.
9. 沈英皓, 樊嘉, 吴志全, 等. 肝脏局灶性结节性增生 60 例临床分析. 中华普通外科杂志, 2005, 20(7): 397-399.
10. 孟凡宇, 陈金明, 李盈. 肝脏局灶性结节性增生的临床诊治 176 例. 世界华人消化杂志, 2014, 22(28): 4333-4337.
11. Luciani A, Kobeiter H, Maison P, et al. Focal nodular hyperplasia of the liver in men: is presentation the same in men and women? Gut, 2002, 50(6): 877-880.
12. Kinoshita M, Takemura S, Tanaka S, et al. Ruptured focal nodular hyperplasia observed during follow-up: a case report. Surg Case Rep, 2017, 3(1): 44.
13. Rahili A, Cai J, Trastour C, Juwid A, et al. Spontaneous rupture and hemorrhage of hepatic focal nodular hyperplasia in lobus caudatus. J Hepatobiliary Pancreat Surg, 2005, 12(2): 138-142.
14. Becker YT, Raiford DS, Webb L, et al. Rupture and hemorrhage of hepatic focal nodular hyperplasia. Am Surg, 1995, 61(3): 210-214.
15. Burgio MD, Ronot M, Salvaggio G, et al. Imaging of hepatic focal nodular hyperplasia: pictorial review and diagnostic strategy. Semin Ultrasound CT MR, 2016, 37(6): 511-524.
16. Kong WT, Wang WP, Huang BJ, et al. Contrast-enhanced ultrasound in combination with color Doppler ultrasound can improve the diagnostic performance of focal nodular hyperplasia and hepatocellular adenoma. Ultrasound Med Biol, 2015, 41(4): 944-951.
17. Zhang HT, Gao XY, Xu QS, et al. Evaluation of the characteristics of hepatic focal nodular hyperplasia: correlation between dynamic contrast-enhanced multislice computed tomography and pathological findings. Onco Targets Ther, 2016, 9: 5217-5224.
18. Rousseau C, Ronot M, Vilgrain V, et al. Optimal visualization of focal nodular hyperplasia: quantitative and qualitative evaluation of single and multiphasic arterial phase acquisition at 1.5 T MR imaging. Abdom Radiol (NY), 2016, 41(5): 990-1000.
19. Suh CH, Kim KW, Kim GY, et al. The diagnostic value of Gd-EOB-DTPA-MRI for the diagnosis of focal nodular hyperplasia: a systematic review and meta-analysis. Eur Radiol, 2015, 25(4): 950-960.
20. 唐艳华, 张峰, 王海屹, 等. 肝脏局灶性结节增生的不典型常规 MRI 影像表现. 中华医学杂志, 2016, 96(7): 544-546.
21. Mamone G, Caruso S, Cortis K, et al. Complete spontaneous regression of giant focal nodular hyperplasia of the liver: Magnetic resonance imaging evaluation with hepatobiliary contrast media. World J Gastroenterol, 2016, 22(47): 10461-10464.
22. Kudo M, Zheng RQ, Chung H, et al. Long-term follow-up of atypical progressive focal nodular hyperplasia increasing in size and number implicates its pathogenesis. Am J Gastroenterol, 2008, 103(8): 2153-2155.
23. Sadowski DC, Lee SS, Wanless IR, et al. Progressive type of focal nodular hyperplasia characterized by multiple tumors and recurrence. Hepatology, 1995, 21(4): 970-975.
24. Tajiri K, Tsuneyama K, Kawai K, et al. A case of progressing focal nodular hyperplasia and its molecular expression pattern. Clin J Gastroenterol, 2014, 7(3): 271-277.
25. Hau HM, Atanasov G, Tautenhahn HM, et al. The value of liver resection for focal nodular hyperplasia: resection yes or no? Eur J Med Res, 2015, 20: 86.
26. 张建伟, 王成锋, 刘骞, 等. 肝脏局灶性结节性增生的临床诊治分析, 中华医学杂志, 2007, 87(36): 2531-2533.
27. Perrakis A, Demir R, Müller V, et al. Management of the focal nodular hyperplasia of the liver: evaluation of the surgical treatment comparing with observation only. Am J Surg, 2012, 204(5): 689-696.

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Diagnosis and treatment of hepatic focal nodular hyperplasia (Analysis of 22 cases)

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