Hepatic adenoma and focal nodular hyperplasia: Diagnosis and criteria for treatment (original) (raw)

Focal nodular hyperplasia and hepatic adenoma: current diagnosis and management

Updates in Surgery, 2013

Benign liver tumors are common lesions that can be classified into cystic and solid lesions. Cystic lesions are the most frequent; however, they rarely represent a diagnostic or therapeutic challenge. In contrast, solid lesions are more difficult to characterize and management remains controversial. The wide availability and use of advanced imaging modalities, including ultrasonography, computed tomography, and magnetic resonance imaging have led to increased identification of incidental liver masses. Although some of these incidentally discovered masses are malignant, most are benign and must be included in the differential diagnosis. In this article we review FNH and HA. Its etiology, biological behavior, diagnosis, and treatment will be highlighted.

Histologic scoring of liver biopsy in focal nodular hyperplasia with atypical presentation

Hepatology, 2002

The contribution of radio-guided transcutaneous biopsy in the diagnosis of focal nodular hyperplasia (FNH) of the liver was compared with the findings on surgical specimens to assess its contribution in clinical and radiologic atypical cases. This retrospective study involved 30 patients with atypical tumors on imaging who underwent liver biopsy and then surgery. All surgical specimens were diagnosed as FNH, either classical (n ‫؍‬ 18) or nonclassical (n ‫؍‬ 12). Imaging data were reviewed according to 4 radiologic criteria on magnetic resonance imaging (MRI) and/or computed tomography (CT) scan (hypervascularity, homogeneity, nonencapsulation, and presence of a central scar), and classified depending on the number of criteria found (group I, 4 of 4; group II, 3 of 4; group III, 2 or fewer). Histologic assessment of ultrasound (US)-guided liver biopsy recorded major diagnostic features (fibrous bands, thick-walled vessels, reactive ductules, and nodularity) and minor features (sinusoidal dilatation and perisinusoidal fibrosis). "Definite FNH" (3 or 4 major features) was diagnosed in 14 biopsies, "possible FNH" (2 major and 1 or 2 minor features) in 7 cases, and "negative for FNH" (2 or fewer major features without minor features) in 9 cases. The diagnosis of FNH on biopsy was reached in 14 cases (58.3%) in patients with 2 or fewer imaging criteria (group III; n ‫؍‬ 24). Biopsies with a diagnosis of "possible FNH" corresponded to a large proportion of telangiectatic-type FNH on the specimen. In conclusion, liver biopsy does not appear to be necessary in cases in which imaging is typical. However, the absence of radiologic diagnostic criteria in FNH does not preclude a positive diagnosis on liver needle biopsy. Using the proposed histologic scoring system, surgical management may be avoided in these cases. (HEPATOLOGY 2002;35:414-420.) Abbreviations: FNH, focal nodular hyperplasia; CT, computed tomography; MRI, magnetic resonance imaging; US, ultrasound.

Benign Liver Tumors: Differential Diagnosis and Indications for Surgery

World Journal of Surgery, 1997

The differential diagnosis for hemangioma, focal nodular hyperplasia (FNH), and hepatocellular adenoma may be difficult. Reliable diagnosis is mandatory for the decision of whether to apply surgery or observation. Experience with long-term observation in nonoperated patients with hemangioma and FNH is limited. A group of 437 patients from a single institution were analyzed with regard to a diagnostic algorithm, the indications for surgery, and observation. There were 238 hemangiomas, 150 cases of FNH, 44 adenomas, and 5 mixed tumors. Of the 437 patients, 173 underwent surgery; 103 with hemangioma and 54 with FNH were observed at our own institution, whereas 117 patients underwent follow-up elsewhere or were lost. Among the operated patients with confirmed histology, a good diagnostic yield was found for a combination of ultrasonography (US), contrast (bolus)enhanced computed tomography (CT), and labeled red blood cell (RBC) scanning: sensitivity 85.7%, specificity 100%, positive predictive value (PPV) 100%, negative predictive value (NPV) 81.8%, and accuracy 91.3%. For FNH the combination of US and CT plus cholescintigraphy showed a sensitivity 82.1%, specificity 97.1%, PPV 95.8%, NPV 84.6%, and accuracy 90.3%. Surgical mortality was 0.6%. Observation of patients with hemangioma and FNH for a median of 32 months revealed no increase in tumor size in 80% and a decrease in fewer than 7%. There was no tumor rupture and no evidence of malignant transformation. We concluded that liver hemangioma and FNH can be differentiated from adenoma with high sensitivity, specificity, and accuracy by labeled RBC scanning and cholescintigraphy in combination with US and contrast-enhanced CT. In the case of symptoms or an equivocal diagnosis with respect to adenoma or hepatocellular carcinoma, surgery can be performed with very low risk. Because in asymptomatic patients with observed hemangioma or FNH no increase of tumor size can be expected for many years, the indications for surgery must be carefully evaluated.

Focal Nodular Hyperplasia and Hepatocellular Adenoma of the Liver

American Journal of Roentgenology, 2001

Introduction: the history of benign liver cell tumors, namely, focal nodular hyperplasia (FNH), and hepatocellular adenoma (HcA), has recently progressed thanks to molecular biology and imaging studies that made it possible a new classification used in European, American and East countries. case report: A review was performed of the numerous published articles, with focus on the management and clinical outcome of benign liver cell tumors is an attempt to promote more standardized guidelines. conclusion: the discovery of genetic drivers of HcA has refined our knowledge of the life history of HcA from risk factors of malignant transformation. the clinical management of FNH and HcA have changed in the recent years. this will have an impact on the management of these lesions including surveillance.

FNH-like nodules: Possible precursor lesions in patients with focal nodular hyperplasia (FNH)

Comparative hepatology, 2003

BACKGROUND: The typical lesion of focal nodular hyperplasia (FNH) is a benign tumor-like mass characterized by hepatocytic nodules separated by fibrous bands. The solitary central artery with high flow and the absent portal vein give the lesions their characteristic radiological appearance. The great majority of cases seen in daily practice conform to the above description. Additional small nodules (from 1-2 up to 15-20 mm in diameter) detected by imaging techniques or on macroscopic examination may be difficult to identify as representing FNH if they lack the key features of FNH as defined in larger lesions. The aim of this study was to characterize these small nodules, and to compare their characteristics with those of typical lesions of FNH present in the same specimens. RESULTS: Eight patients underwent hepatic resections for the removal of a mass lesion ("nodule") diagnosed as: FNH (1 patient); nodules of unknown nature (5 patients); or nodules thought to be adenoma o...

Early-stage focal nodular hyperplasia: US/CT/MR features correlated with histology

European Radiology, 1994

sels, bile ducts, and Kuppfer cells . A central scar is its macroscopic hallmark. Often asymptomatic, only in 10 % of cases are mass-related symptoms present. The origin of FNH is unknown and it does not seem to be related to steroids or oral contraceptive therapy, although it prevails in young women (age range: 3rd to 5th decades of life) with a 2:1 female/male ratio . The main diagnostic problem is to differentiate FNH from hepatic adenoma, since the latter is prone to hemorrhage, and may develop into hepat~cellular carcinoma. A differentiating feature between he2 patic adenoma and FNH is the presence of intratumoral hemorrhage, which has been reported in 15-33 % of hepatic adenomas [5-7], but rarely described in FNH at presentation .

Focal nodular hyperplasia, hepatocellular adenomas: Past, present, future

Gastroentérologie Clinique et Biologique, 2010

In the 1958 monograph on liver tumors, Edmondson established that we have to distinguish between two basically different forms of benign liver tumors. For one, he reserved the designation hepatocellular adenoma (HCA), for the second the term focal nodular hyperplasia (FNH) .