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Focal nodular hyperplasia is a benign tumor of the liver (hepatic tumor), which is the second most prevalent tumor of the liver after hepatic hemangioma.[1] It is usually asymptomatic, rarely grows or bleeds, and has no malignant potential.[2] This tumour was once often resected because it was difficult to distinguish from hepatic adenoma, but with modern multiphase imaging it is usually now diagnosed by strict imaging criteria and not resected.
Ultrasound of malformed vessels within the fibrous scar of focal nodular hyperplasia.Liver tumor types by relative incidence in adults in the United States, with focal nodular hyperplasia at right.[3]
Focal nodular hyperplasia's most recognizable gross feature is a central stellate scar seen in 60–70% of cases. Microscopically, a lobular proliferation of bland-appearing hepatocytes with a bile ductular proliferation and malformed vessels within the fibrous scar is the most common pattern. Other patterns include telangiectatic, hyperplastic-adenomatous, and lesions with focal large-cell dysplasia.[4] Rarely, these lesions may be multiple or can occur as part of a syndrome with hemangiomas, epithelioid hemangioendothelioma, hepatic adenomas, fibrolamellar hepatocellular carcinoma, vascular malformations of the brain, meningiomas, and/or astrocytomas.[4]
Pathophysiologyedit
Focal nodular hyperplasia is not a neoplasm; it is believed to result from localized hyperplastic hepatocyte response to an underlying congenital arteriovenous malformation.[2] It consists of normal liver constituents in an abnormally organized pattern, grows in a stellate pattern and may display central necrosis when large.[5] Additionally evidence suggests that the incidence of focal nodular hyperplasia is related to oral contraceptive use.[6]
Diagnosisedit
Unenhanced CT or MRI usually does not show the difference in intensity between the focal nodular hyperplasia and surrounding liver except when there is marked liver steatosis that reduces the attenuation of the liver, causing focal nodular hyperplasiato be hyperattenuating when compared with the surrounding liver. In the arterial phase CT or MRI, there is a strong enhancement not followed by washout. The lesion presents a slight hyperintensity or isodensity on portal venous phase or delayed phase images. There is also a presence of a central scar and absence of a capsule for the focal nodular hyperplasia.[7]
Treatmentedit
Frequent monitoring through periodic imaging at intervals of three to six months is advised. Nevertheless, in cases where a patient exhibits symptoms, when there are suspicions of an underlying malignancy following an inconclusive biopsy, or when a lesion demonstrates sustained growth, medical professionals commonly opt for a biopsy or surgical removal. Surgical resection remains the established and definitive course of treatment.[8]
Epidemiologyedit
The prevalence of focal nodular hyperplasia in individuals undergoing evaluation with an ultrasound of the abdomen is 0.03%.[9] About 20% of focal nodular hyperplasia lesions are associated with hepatic hemangiomas.[9]
Notesedit
^Naganuma, Hiroko; Ishida, Hideaki; Ogawa, Masahiro; Watanabe, Yukinobu; Watanabe, Daisuke; Ohyama, Yoko; Watanabe, Takako (January 2017). "Focal nodular hyperplasia: our experience of 53 Japanese cases". Journal of Medical Ultrasonics (2001). 44 (1): 79–88. doi:10.1007/s10396-016-0734-9. ISSN 1613-2254. PMID 27550510.
^Table 37.2 in: Sternberg, Stephen (2012). Sternberg's diagnostic surgical pathology. Place of publication not identified: LWW. ISBN978-1-4511-5289-0. OCLC 953861627.
^ abNguyen, Bich N.; Fléjou, Jean-François; Terris, Benoit; Belghiti, Jacques; Degott, Claude (1999). "Focal Nodular Hyperplasia of the Liver". The American Journal of Surgical Pathology. 23 (12): 1441–54. doi:10.1097/00000478-199912000-00001. PMID 10584697.
^Imaging in Focal Nodular Hyperplasia at eMedicine
^Scalori, Astrid; Tavani, Alessandra; Gallus, Silvano; La Vecchia, Carlo; Colombo, Massimo (2002). "Oral contraceptives and the risk of focal nodular hyperplasia of the liver: A case-control study". American Journal of Obstetrics and Gynecology. 186 (2): 195–7. doi:10.1067/mob.2002.120277. PMID 11854634.
^Dioguardi Burgio, Marco; Ronot, Maxime; Salvaggio, Giuseppe; Vilgrain, Valérie; Brancatelli, Giuseppe (December 2016). "Imaging of Hepatic Focal Nodular Hyperplasia: Pictorial Review and Diagnostic Strategy". Seminars in Ultrasound, CT and MRI. 37 (6): 511–524. doi:10.1053/j.sult.2016.08.001. PMID 27986170.
^ abMyers, L; Ahn, J (August 2020). "Focal Nodular Hyperplasia and Hepatic Adenoma: Evaluation and Management". Clinics in Liver Disease. 24 (3): 389–403. doi:10.1016/j.cld.2020.04.013. PMID 32620279. S2CID 220335859.
Referencesedit
Chun Hsee, Li; McCall, John L.; Koea, Jonathan B. (2005). "Focal nodular hyperplasia: what are the indications for resection?". HPB. 7 (4): 298–302. doi:10.1080/13651820500273624. PMC2043107. PMID 18333211.
External linksedit
December 18, 2023
focal, nodular, hyperplasia, this, article, needs, more, reliable, medical, references, verification, relies, heavily, primary, sources, please, review, contents, article, appropriate, references, unsourced, poorly, sourced, material, challenged, removed, find. This article needs more reliable medical references for verification or relies too heavily on primary sources Please review the contents of the article and add the appropriate references if you can Unsourced or poorly sourced material may be challenged and removed Find sources Focal nodular hyperplasia news newspapers books scholar JSTOR March 2022 Focal nodular hyperplasia is a benign tumor of the liver hepatic tumor which is the second most prevalent tumor of the liver after hepatic hemangioma 1 It is usually asymptomatic rarely grows or bleeds and has no malignant potential 2 This tumour was once often resected because it was difficult to distinguish from hepatic adenoma but with modern multiphase imaging it is usually now diagnosed by strict imaging criteria and not resected Focal nodular hyperplasiaMicrograph of focal nodular hyperplasia H amp E stain SpecialtyGastroenterology Contents 1 Presentation 2 Pathophysiology 3 Diagnosis 4 Treatment 5 Epidemiology 6 Notes 7 References 8 External linksPresentation edit nbsp Ultrasound of malformed vessels within the fibrous scar of focal nodular hyperplasia nbsp Liver tumor types by relative incidence in adults in the United States with focal nodular hyperplasia at right 3 Focal nodular hyperplasia s most recognizable gross feature is a central stellate scar seen in 60 70 of cases Microscopically a lobular proliferation of bland appearing hepatocytes with a bile ductular proliferation and malformed vessels within the fibrous scar is the most common pattern Other patterns include telangiectatic hyperplastic adenomatous and lesions with focal large cell dysplasia 4 Rarely these lesions may be multiple or can occur as part of a syndrome with hemangiomas epithelioid hemangioendothelioma hepatic adenomas fibrolamellar hepatocellular carcinoma vascular malformations of the brain meningiomas and or astrocytomas 4 Pathophysiology editFocal nodular hyperplasia is not a neoplasm it is believed to result from localized hyperplastic hepatocyte response to an underlying congenital arteriovenous malformation 2 It consists of normal liver constituents in an abnormally organized pattern grows in a stellate pattern and may display central necrosis when large 5 Additionally evidence suggests that the incidence of focal nodular hyperplasia is related to oral contraceptive use 6 Diagnosis editUnenhanced CT or MRI usually does not show the difference in intensity between the focal nodular hyperplasia and surrounding liver except when there is marked liver steatosis that reduces the attenuation of the liver causing focal nodular hyperplasiato be hyperattenuating when compared with the surrounding liver In the arterial phase CT or MRI there is a strong enhancement not followed by washout The lesion presents a slight hyperintensity or isodensity on portal venous phase or delayed phase images There is also a presence of a central scar and absence of a capsule for the focal nodular hyperplasia 7 Treatment editFrequent monitoring through periodic imaging at intervals of three to six months is advised Nevertheless in cases where a patient exhibits symptoms when there are suspicions of an underlying malignancy following an inconclusive biopsy or when a lesion demonstrates sustained growth medical professionals commonly opt for a biopsy or surgical removal Surgical resection remains the established and definitive course of treatment 8 Epidemiology editThe prevalence of focal nodular hyperplasia in individuals undergoing evaluation with an ultrasound of the abdomen is 0 03 9 About 20 of focal nodular hyperplasia lesions are associated with hepatic hemangiomas 9 Notes edit Naganuma Hiroko Ishida Hideaki Ogawa Masahiro Watanabe Yukinobu Watanabe Daisuke Ohyama Yoko Watanabe Takako January 2017 Focal nodular hyperplasia our experience of 53 Japanese cases Journal of Medical Ultrasonics 2001 44 1 79 88 doi 10 1007 s10396 016 0734 9 ISSN 1613 2254 PMID 27550510 a b Hamad Sammy Willyard Charles E Mukherjee Sandeep 2023 Focal Nodular Hyperplasia StatPearls Treasure Island FL StatPearls Publishing PMID 30335277 retrieved 2023 11 03 Table 37 2 in Sternberg Stephen 2012 Sternberg s diagnostic surgical pathology Place of publication not identified LWW ISBN 978 1 4511 5289 0 OCLC 953861627 a b Nguyen Bich N Flejou Jean Francois Terris Benoit Belghiti Jacques Degott Claude 1999 Focal Nodular Hyperplasia of the Liver The American Journal of Surgical Pathology 23 12 1441 54 doi 10 1097 00000478 199912000 00001 PMID 10584697 Imaging in Focal Nodular Hyperplasia at eMedicine Scalori Astrid Tavani Alessandra Gallus Silvano La Vecchia Carlo Colombo Massimo 2002 Oral contraceptives and the risk of focal nodular hyperplasia of the liver A case control study American Journal of Obstetrics and Gynecology 186 2 195 7 doi 10 1067 mob 2002 120277 PMID 11854634 Dioguardi Burgio Marco Ronot Maxime Salvaggio Giuseppe Vilgrain Valerie Brancatelli Giuseppe December 2016 Imaging of Hepatic Focal Nodular Hyperplasia Pictorial Review and Diagnostic Strategy Seminars in Ultrasound CT and MRI 37 6 511 524 doi 10 1053 j sult 2016 08 001 PMID 27986170 Fodor Margot Primavesi Florian Braunwarth Eva Cardini Benno Resch Thomas Bale Reto Putzer Daniel Henninger Benjamin Oberhuber Rupert Maglione Manuel Margreiter Christian Schneeberger Stefan Ofner Dietmar Stattner Stefan 2018 Indications for liver surgery in benign tumours European surgery ACA Acta chirurgica Austriaca 50 3 125 131 doi 10 1007 s10353 018 0536 y ISSN 1682 8631 PMC 5968066 PMID 29875801 a b Myers L Ahn J August 2020 Focal Nodular Hyperplasia and Hepatic Adenoma Evaluation and Management Clinics in Liver Disease 24 3 389 403 doi 10 1016 j cld 2020 04 013 PMID 32620279 S2CID 220335859 References editChun Hsee Li McCall John L Koea Jonathan B 2005 Focal nodular hyperplasia what are the indications for resection HPB 7 4 298 302 doi 10 1080 13651820500273624 PMC 2043107 PMID 18333211 External links edit Retrieved from https en wikipedia org w index php title Focal nodular hyperplasia amp oldid 1183313712, wikipedia, wiki, book, books, library,
