Hepatic Focal Nodular Hyperplasia Developing after Childhood Cancers: Two-Center’s Experience from Turkey (original) (raw)
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Benign Hepatic Nodular Lesions After Treatment for Childhood Cancer
Journal of Pediatric Gastroenterology & Nutrition, 2013
Background: Benign nodular hepatic regenerating lesions such as focal nodular hyperplasia (FNH) have been reported as rare complications of the antineoplastic therapy received during infancy. Little is known about the risk factors associated with the onset of these lesions and their diagnostic management. Methods: We have analyzed a series of benign hepatic nodular lesions occurring in children previously treated for malignant tumors in our institution in a period of 11 years. An extensive description of the imaging presentation of the lesions has been provided to facilitate the differential diagnosis, and a risk factor analysis has been conducted. Results: A total of 14 diagnoses (10 FNH and 4 hemangiomas) of benign nodular hepatic lesions have been found. Hematopoietic stem cell transplantation is the most important statistically independent risk factor associated with the development of these lesions, especially for FNH. No malignant transformation of nodules has been recorded during a median follow-up time of 4 years. Conclusions: In our experience, FNH is the most frequent benign nodular hepatic lesions occurring after treatment for childhood cancer. Hematopoietic stem cell transplantation is the most important risk factor to be taken in account. After a secure diagnosis of these benign lesions, only a close imaging follow-up is recommended.
Focal Nodular Hyperplasia of the Liver in a 5-year-old Girl
Journal of the Chinese Medical Association, 2010
Focal nodular hyperplasia of the liver is a benign tumor that usually affects young women. Traditionally, its treatment in children has been conservative. As a result of its rarity in childhood, its differential diagnosis with other liver tumors is challenging. We present the case of a 5-year-old girl with a 1-week history of fever and abdominal pain. No definite diagnosis could be obtained after serial imaging and liver biopsy. As a result of uncertainty in the imaging and needle biopsy results, the patient underwent complete tumor resection. Pathology showed focal nodular hyperplasia that affected the right lobe of the liver. After surgery, the child was doing well at 24 months of follow-up. [J Chin Med Assoc 2010; 73(11):611-614]
Focal nodular hyperplasia in pediatric patients with and without oncologic history
Pediatric Blood & …, 2010
The diagnosis of FNH is warranted by the possibility of avoiding unnecessary hepatic resections. The 18 patients of our series, 6 of whom were long-term survivors of malignant, non-hepatic tumors, underwent either a biopsy or a complete excision to obtain the diagnosis. The imaging characteristics could not be considered pathognomonic. The lesion remained stable after the biopsy in 8 patients; no complications were observed in other 10 patients who underwent resection of the mass. The outcome of all our patients with or without previous oncological disease was benign.
Benign Hepatocellular Tumors in Children: Focal Nodular Hyperplasia and Hepatocellular Adenoma
International Journal of Hepatology, 2013
Benign liver tumors are very rare in children. Most focal nodular hyperplasia (FNH) remain sporadic, but predisposing factors exist, as follows: long-term cancer survivor (with an increasing incidence), portal deprivation in congenital or surgical portosystemic shunt. The aspect is atypical on imaging in two-thirds of cases. Biopsy of the tumor and the nontumoral liver is then required. Surgical resection will be discussed in the case of large tumors with or without symptoms. In the case of associated vascular disorder with portal deprivation, restoration of the portal flow will be discussed in the hope of seeing the involution of FNH. HepatoCellular Adenoma (HCA) is frequently associated with predisposing factors such as GSD type I and III, Fanconi anemia especially if androgen therapy is administered, CPSS, and SPSS. Adenomatosis has been reported in germline mutation of HNF1-α. Management will depend on the presence of a predisposing factor and may include metabolic control, andr...
Focal nodular hyperplasia in a 14-year-old child: A case report
Caspian Journal of Internal Medicine, 2021
Background: Focal nodular hyperplasia (FNH) is a benign rare liver neoplasm in children and includes only 2% of all pediatric liver tumors. Here we reported the case of a 14-yearold girl with vague flank pain who was managed conservatively. Case Presentation: Our case is a 14-year-old child (female), with a 5 cm diameter lesion in the right lobe of the liver in CT scan, and histologic findings compatible with FNH. A solid mass lobulated contour, intense enhancement with a hypodense central area, possibly indicative of central scar, was seen. Despite her mild flank pain we did not insist on surgical resection and managed her conservatively. Her pain resolved 2 weeks later and an imaging follow-up with ultrasound 6 months later showed no increase in size or numbers. Conclusion: FNH is an uncommon mass lesion in children. Our patient had mild symptomatic severity, and several guidelines recommend surgical treatment in this condition, but our team performed conservative and medical treatment for her and got the desired result. Therefore, the combination of these factors raises the importance of introducing the case. According to FNH's nature, stability, complications, and evaluation of pain are essential to avoid unnecessary surgeries.
Focal nodular hyperplasia in children: An institutional experience with review of the literature
Journal of Pediatric Surgery, 2015
Background: Focal nodular hyperplasia (FNH) is uncommonly diagnosed in pediatric patients and may be difficult to distinguish from a malignancy. We present a review of all children with a tissue diagnosis of FNH at our institution, describe the diagnostic modalities, and provide recommendations for diagnosis and follow-up based on our experience and review of the literature. Methods: A retrospective review of children b18 years of age diagnosed with FNH at a single institution was performed from 2000 to 2013. Results: Twelve patients were identified with a tissue diagnosis of FNH. Two patients required surgical resection of their lesion owing to concern for malignancy. Ten patients were managed expectantly with imaging surveillance after biopsy confirmed a diagnosis of FNH. All patients who underwent MRI had very typical findings including hypointensity on T1 weighted sequences, hyperintensity on T2, and homogenous uptake of contrast on the arterial phase. On follow-up all patients had either a stable lesion or reduction in size. Conclusions: Focal nodular hyperplasia presents typically in children with liver disease, have undergone chemotherapy, and adolescent females. Young children, particularly b5 years of age, without underlying liver disease or history of chemotherapy can pose a diagnostic dilemma. In this unique subgroup of children with FNH, MRI and/or needle biopsy should be adequate diagnostic modalities for these lesions.
Clinical Nuclear Medicine, 2011
Hepatoblastoma (HB) is the most common pediatric liver cancer representing 1% of all pediatric malignances and occurring mostly within 5 years of age. Liver recurrences and secondary lesions (abdomen, lung, and brain) can occur. Surgery and chemotherapy are widely accepted. Focal nodular hyperplasia (FNH) is a benign, usually asymptomatic, and incidental hepatic tumor with an unclear etiology, good prognosis, and its clinic management should be conservative. FNH could be evaluated by ultrasonography, computed tomography, and magnetic resonance imaging. Nuclear medicine procedures do not have an effective role in evaluating HB/FNH but F-18 FDG PET/CT represents a new option. We report a case of a child with a lesion suspect for HB at magnetic resonance imaging and negative F-18 FDG PET/CT with histologic diagnosis of FNH after resection.
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.