A case of hepatocellular carcinoma arising within large focal nodular hyperplasia with review of the literature (original) (raw)

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.

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) .

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.

Hepatic Focal Nodular Hyperplasia: A Benign Incidentaloma or a Marker of Serious Hepatic Disease?

HPB Surgery, 1992

Amongst 17 patients with hepatic focal nodular hyperplasia (FNH) encountered at Westmead Hospital between 1981 and 1990, FNH was found in association with hepatocellular carcinoma (HCC) in three (3/ 17), one male and two females, one of whom also had peliosis and an hepatic adenoma. FNH was also found in association with other conditions which may affect hepatic function, structure or circulation, including chronic obstructive airways disease (2), congestive cardiomyopathy (1), chronic active hepatitis (1), granulomatous hepatitis (1), coeliac artery stenosis (1) and metastatic malignant melanoma (1). This report, derived from our experience with FNH over 10 years draws attention to a possible link between FNH, hepatic malignancy and conditions which may disturb the hepatic circulation. We suggest that patients with FNH should be investigated thoroughly and an aggressive management policy should be adopted.

Telangiectatic focal nodular hyperplasia: a variant of hepatocellular adenoma

Gastroenterology, 2004

Background & Aims: "Telangiectatic focal nodular hyperplasia" designate atypical lesions considered as variants of focal nodular hyperplasia (FNH). However, because "telangiectatic FNH" share several morphologic patterns with hepatocellular adenomas, classification of such lesions deserve further clarification. Therefore, the aim of the present study was to reconsider the classification of telangiectatic FNH with the help of a molecular approach. Methods: Ten telangiectatic FNH, 6 typical FNH, and 6 hepatocellular adenomas were studied. DNA, RNA, and protein from each lesion were extracted. Clonality was assessed by the study of the X chromosome inactivation pattern (HUMARA assay). Angiopoietin (ANGPT-1 and ANGPT-2) mRNA, genes the expression of which is typically modified in FNH, were quantified by a real-time RT-PCR procedure. Protein profiles were analyzed by SELDI-TOF PROTEINCHIP (Cyphergen Biosystem, Inc., Fremont, CA) technology. Results: Although all informative cases of FNH (5 of 6) and hepatocellular adenomas (6 of 6) were polyclonal and monoclonal, respectively, clonal analysis showed a nonrandom pattern of X chromosome inactivation consistent with a monoclonal lesion in 6 of 8 cases of telangiectatic FNH. The mean value of the ANGPT-1/ANGPT-2 mRNA ratio was 21.4 in FNH, 2.6 in adenomas, and 2.1 in telangiectatic FNH (P < 0.001 in telangiectatic FNH vs. FNH). SELDI-TOF PROTEINCHIP profiling and hierarchical clustering analysis showed that all except 1 telangiectatic FNH clustered within the group of hepatocellular adenomas. Conclusions: These results show that telangiectatic FNH display a molecular pattern closer to that of hepatocellular adenomas than to FNH and suggest that these lesions should instead be referred to as "telangiectatic hepatocellular adenomas." F ocal nodular hyperplasia (FNH) is a frequent benign lesion of the liver, usually observed in female patients. 1,2 Morphologically, FNH is characterized by a central fibrous scar containing numerous dystrophic vessels and reactive ductules surrounded by regenerative hepatocyte nodules. A distinct entity referred to as "tel-angiectatic FNH" has been recently described. This lesion is characterized by marked vascular disorders, including sinusoidal dilatation and peliosis, without significant fibrosis. 3-5 Such morphologic changes are also classic hallmarks of hepatocellular adenomas, resulting in difficulty in diagnosis on the basis of morphologic, radiologic, and pathologic aspects. 6 This also results in ambiguity in the classification of these telangiectatic lesions, thus requiring further clarification.

Focal Nodular Hyperplasia of the Liver Presenting as Right Upper Quadrant Mass

Journal of Case Reports, 2018

Background: Focal nodular hyperplasia (FNH) is the second most common benign liver tumor, which in the vast majority of cases occurs in young women. The lesion is often discovered incidentally as a result of the widespread availability and application of modern cross-sectional imaging on the abdomen. We herein present a case of symptomatic FNH that had successful resection. Case Report: A 22-year old female patient with a history of recurrent right upper quadrant abdominal pain of 11 years duration was reviewed in our facility. Abdominal examination revealed a roughly mobile oval swelling in the right upper quadrant. Contrast abdominal computerized tomography scan revealed a mass isoattenuating in density relative to muscle, enhanced intravenous contrast and displacing bowel loops measuring 13.9×8.3 cm in the transverse mesocolon. She had resection of the mass with an excellent post-operative quality of life. Pathological examination using Hematoxylin-eosin staining examination revealed focal nodular hyperplasia of the liver. Conclusion: Symptomatic focal nodular hyperplasia can be safely resected with excellent rates of morbidity and zero mortality.

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.