Diagnosis and Treatment of Hepatic Focal Nodular Hyperplasia (Report of 21 Cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Zhengxu ¹ , HU Guifang ² , WU Mengchao ³

Department of General Surgery, Lanzhou General Hospital, Lanzhou Military Command, Chinese PLA, Lanzhou 730050，China;

Corresponding author：

Keywords：

Focal nodular hyperplasia; Liver; Diagnosis; Treatment

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

ObjectiveTo explore the clinical features and sum up the laws of the hepatic focal nodular hyperplasia (FNH) in its diagnosis and treatment. MethodsFNH was an uncommon benign hepatic tumor that often posed diagnostic dilemmas. We analyzed retrospectively the clinical, imaging of ultrasound, imaging of computed tomography (CT) and magnetic resonance images (MRI), and pathological materials of 21 patients with FNH proven by the pathological diagnosis during 5 years from April 1996 through April 2001 in two hospitals. ResultsThe diagnosis of FNH remained a challenge for clinicians and surgeons. Rate of correct diagnosis of FNH was low preoperatively (19.0%). The lesions of FNH were seen in males and females (m/f: 14/7). Only three female patients (3/7) had the history of taking oral contraceptive. Patients with FNH were largely young and middle age persons (81.0% under 50 years), discovered by accident (57.1%), without infection of the hepatitis B virus (95.2%) and with normal liver functions (100%) and serum AFP levels (100%). Color Doppler ultrasound showed blood vessels passing through the lesion (80.0%) and there was abundant in blood (66.7%). CT scan showed that the lesion had transient immediate enhancement in 60.0% of patients and had homogeneous signal in 60.0% after bolus injection. MR imaging demonstrated early vigorous enhancement (64.3%), homogenous signal (57.1%) and having central scar (35.7%) in the lesion. The demonstration of a central scar in the lesion was very helpful for the diagnosis of FNH. MRI was more helpful for the diagnosis of FNH using liver specific contrast agents: superparamagnetic iron oxide（SPIO）. All patients underwent focus resection (18 cases) or segmentectomy (2 cases), except one having no treatment. ConclusionFNH shows some typical clinical and imaging features. We could increase the rate of correct diagnosis by comprehensively analyzing the clinical and imaging materials. It is very important and necessary to determine a definite diagnosis of FNH, hepatic adenoma (HA) and primary liver cancer (PLC) preoperatively, because the HA and PLC must be surgically resected, FNH can only be followed up.

Citation： WANG Zhengxu,HU Guifang,WU Mengchao. Diagnosis and Treatment of Hepatic Focal Nodular Hyperplasia (Report of 21 Cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2003, 10(2): 147-150. doi: Copy

1.	吴孟超主编. 肝脏外科学 [M]. 第2版. 上海: 上海科学技术文献出版社，2000∶ 386~389.
2.	Reddy KR， Kligerman S， Levi J， et al. Benign and solid tumors of the liver: relationship to sex, age, size of tumors, and outcome [J]. Am Surg, 2001; 67(2)∶173.
3.	Kehagias D, Moulopoulos L, Antoniou A, et al. Focal nodular hyperplasia: imaging findings [J]. Eur Radiol, 2001; 11(2)∶202.
4.	Bartolozzi C, Lencioni R, Paolicchi A, et al. Differentiation of hepatocellular adenoma and focal nodular hyperplasia of the liver: comparison of power Doppler imaging and conventional color Doppler sonography [J]. Eur Radiol，1997; 7(9)∶1410.
5.	Colle I, de Beeck BO, Hoorens A, et al. Multiple focal nodular hyperplasia [J]. J Gastroenterol，1998; 33(6)∶904.
6.	Schlott T，Ahrens K， Ruschenburg I， et al. Different gene expression of MDM2, GAGE1, 2 and FHIT in hepatocellular carcinoma and focal nodular hyperplasia [J]. Br J Cancer, 1999; 80(1-2)∶ 73.
7.	Wang LY, Wang JH, Lin ZY, et al. Hepatic focal nodular hyperplasia: findings on color Doppler ultrasound [J]. Abdom Imaging, 1997; 22(2)∶178.
8.	Mortele KJ, Stubbe J, Praet M, et al. Intratumoral steatosis in focal nodular hyperplasia coinciding with diffuse hepatic steatosis: CT and MRI findings with histologic correlation [J]. Abdom Imaging, 2000; 25(2)∶179.
9.	Kacl GM, Hagspiel KD, Marincek B. Focal nodular hyperplasia of the liver: serial MRI with GdDOTA, superparamagnetic iron oxide, and GdEOBDTPA [J]. Abdom Imaging, 1997; 22(3)∶264.
10.	Herman P, Pugliese V, Machado MA, et al. Hepatic Adenoma and focal nodular hyperplasia: differential diagnosis and treatment [J]. World J Surg, 2000; 24(3)∶ 372.

1. 吴孟超主编. 肝脏外科学 [M]. 第2版. 上海: 上海科学技术文献出版社，2000∶ 386~389.
2. Reddy KR， Kligerman S， Levi J， et al. Benign and solid tumors of the liver: relationship to sex, age, size of tumors, and outcome [J]. Am Surg, 2001; 67(2)∶173.
3. Kehagias D, Moulopoulos L, Antoniou A, et al. Focal nodular hyperplasia: imaging findings [J]. Eur Radiol, 2001; 11(2)∶202.
4. Bartolozzi C, Lencioni R, Paolicchi A, et al. Differentiation of hepatocellular adenoma and focal nodular hyperplasia of the liver: comparison of power Doppler imaging and conventional color Doppler sonography [J]. Eur Radiol，1997; 7(9)∶1410.
5. Colle I, de Beeck BO, Hoorens A, et al. Multiple focal nodular hyperplasia [J]. J Gastroenterol，1998; 33(6)∶904.
6. Schlott T，Ahrens K， Ruschenburg I， et al. Different gene expression of MDM2, GAGE1, 2 and FHIT in hepatocellular carcinoma and focal nodular hyperplasia [J]. Br J Cancer, 1999; 80(1-2)∶ 73.
7. Wang LY, Wang JH, Lin ZY, et al. Hepatic focal nodular hyperplasia: findings on color Doppler ultrasound [J]. Abdom Imaging, 1997; 22(2)∶178.
8. Mortele KJ, Stubbe J, Praet M, et al. Intratumoral steatosis in focal nodular hyperplasia coinciding with diffuse hepatic steatosis: CT and MRI findings with histologic correlation [J]. Abdom Imaging, 2000; 25(2)∶179.
9. Kacl GM, Hagspiel KD, Marincek B. Focal nodular hyperplasia of the liver: serial MRI with GdDOTA, superparamagnetic iron oxide, and GdEOBDTPA [J]. Abdom Imaging, 1997; 22(3)∶264.
10. Herman P, Pugliese V, Machado MA, et al. Hepatic Adenoma and focal nodular hyperplasia: differential diagnosis and treatment [J]. World J Surg, 2000; 24(3)∶ 372.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Diagnosis and Treatment of Hepatic Focal Nodular Hyperplasia (Report of 21 Cases)

Abstract Full text Figures/Tables Video References Cited by

Format

Content