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Cooper KM, Delk M, Devuni D, Sarkar M. Sex differences in chronic liver disease and benign liver lesions. JHEP Rep 2023; 5:100870. [PMID: 37791378 PMCID: PMC10542645 DOI: 10.1016/j.jhepr.2023.100870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/23/2023] [Accepted: 07/01/2023] [Indexed: 10/05/2023] Open
Abstract
The epidemiology, natural history, and therapeutic responses of chronic liver diseases and liver lesions often vary by sex. In this review, we summarize available clinical and translational data on these aspects of the most common liver conditions encountered in clinical practice, including the potential contributions of sex hormones to the underlying pathophysiology of observed differences. We also highlight areas of notable knowledge gaps and discuss sex disparities in access to liver transplant and potential strategies to address these barriers. Given established sex differences in immune response, drug metabolism, and response to liver-related therapies, emerging clinical trials and epidemiological studies should prioritize dedicated analyses by sex to inform sex-specific approaches to liver-related care.
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Affiliation(s)
- Katherine M. Cooper
- UMass Chan Medical School, Department of Medicine, Division of Gastroenterology/Hepatology, Worcester, MA, United States
| | - Molly Delk
- University of California San Francisco, Department of Medicine, Division of Gastroenterology/Hepatology, San Francisco, CA, United States
| | - Deepika Devuni
- UMass Chan Medical School, Department of Medicine, Division of Gastroenterology/Hepatology, Worcester, MA, United States
| | - Monika Sarkar
- University of California San Francisco, Department of Medicine, Division of Gastroenterology/Hepatology, San Francisco, CA, United States
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2
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Corallo C, Bell J, Laverty A, Mohsin M, Prasad R, Albazaz R. Suspected focal nodular hyperplasia in male adults: 10-year experience from a large liver centre. Abdom Radiol (NY) 2023; 48:2292-2301. [PMID: 37043025 DOI: 10.1007/s00261-023-03896-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 04/13/2023]
Abstract
PURPOSE Focal nodular hyperplasia (FNH) is commonly found in females of reproductive age. In males, the diagnosis is made more cautiously due to its lower incidence and higher incidence of hepatocellular carcinoma, which can have overlapping imaging features. Follow-up or biopsy is sometimes required. This retrospective study aims to assess management of suspected FNH in male adult patients at our institution over a 10-year period. METHODS Male adults (≥ 18 years) suspected of having FNH from January 2010-June 2020 were identified using a departmental radiology information system search. Data was collected from radiology reports and patient pathway manager. RESULTS Of 342 patients with suspected FNH, 62 were male (18.1%; F:M of 4.5:1). We only included patients investigated and followed up by MRI, total of 57 patients. Median age was 40 years (range 18-74 years). Background liver disease present in 21/57 (36.8%), majority with hepatic steatosis. Average number of lesions per patient 1.7. 22/57 (38.6%) had at least one MRI follow-up using liver-specific contrast with 7 lesions demonstrating variation in size (range growth: -3.27 mm/year to + 4 mm/year). In 7 cases, MRI was not definitive; 6 required biopsy and 1 resection. Only 2/7 demonstrated malignancy. Of the total 57 patients, 6 have deceased and none due to a misdiagnosed or mismanaged hepatic lesion. CONCLUSION FNH is relatively uncommon in males, however, our data suggests that lesions with typical MRI characteristics do not require follow-up and diagnosis can be made confidently, similar to females. Any atypical features should prompt a biopsy.
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Affiliation(s)
- Carmelo Corallo
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, St. James's University Hospital, Beckett Street Harehills, Leeds, LS9 7TF, UK.
| | - Joshua Bell
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, St. James's University Hospital, Beckett Street Harehills, Leeds, LS9 7TF, UK
| | - Adam Laverty
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, St. James's University Hospital, Beckett Street Harehills, Leeds, LS9 7TF, UK
| | - Maryam Mohsin
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, St. James's University Hospital, Beckett Street Harehills, Leeds, LS9 7TF, UK
| | - Raj Prasad
- Department of Hepatobiliary and Transplant Surgery, Leeds Teaching Hospitals NHS Trust, St. James's University Hospital, Leeds, UK
| | - Raneem Albazaz
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, St. James's University Hospital, Beckett Street Harehills, Leeds, LS9 7TF, UK
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Liu Y, Zhang J, Wang Z, Ma J, Wang K, Rao D, Zhang M, Lin Y, Wu Y, Yang Z, Dong L, Ding Z, Zhang X, Fan J, Shi Y, Gao Q. Multi-omics characterization reveals the pathogenesis of liver focal nodular hyperplasia. iScience 2022; 25:104921. [PMID: 36060063 PMCID: PMC9436768 DOI: 10.1016/j.isci.2022.104921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/17/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
The molecular landscape and pathogenesis of focal nodular hyperplasia (FNH) have yet to be elucidated. We performed multi-omics approaches on FNH and paired normal liver tissues from 22 patients, followed by multi-level bioinformatic analyses and experimental validations. Generally, FNH had low mutation burden with low variant allele frequencies, and the mutation frequency significantly correlated with proliferation rate. Although no recurrently deleterious genomic events were found, some putative tumor suppressors or oncogenes were involved. Mutational signatures indicated potential impaired mismatch function and possible poison contact. Integrated analyses unveiled a group of FNH specific endothelial cells that uniquely expressed SOST and probably had strong interaction with fibroblasts through PDGFB/PDGFRB pathway to promote fibrosis. Notably, in one atypical FNH (patient No.11) with pronounced copy number variations, we observed a unique immune module. Most FNH are benign, but molecularly atypical FNH still exist; endothelial cell derived PDGFB probably promotes the fibrogenic process in FNH. FNHs are genetically stable, but high mutation cases exist FNHs have unique transcriptomic modules, and they alter in atypical FNH FNH has a unique type of SOST-expressing endothelial cells that may promote fibrosis
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Focal Benign Liver Lesions and Their Diagnostic Pitfalls. Radiol Clin North Am 2022; 60:755-773. [DOI: 10.1016/j.rcl.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ding Z, Lin K, Fu J, Huang Q, Fang G, Tang Y, You W, Lin Z, Lin Z, Pan X, Zeng Y. An MR-based radiomics model for differentiation between hepatocellular carcinoma and focal nodular hyperplasia in non-cirrhotic liver. World J Surg Oncol 2021; 19:181. [PMID: 34154624 PMCID: PMC8215802 DOI: 10.1186/s12957-021-02266-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/18/2021] [Indexed: 12/23/2022] Open
Abstract
Purpose We aimed to develop and validate a radiomics model for differentiating hepatocellular carcinoma (HCC) from focal nodular hyperplasia (FNH) in non-cirrhotic livers using Gd-DTPA contrast-enhanced magnetic resonance imaging (MRI). Methods We retrospectively enrolled 149 HCC and 75 FNH patients treated between May 2015 and May 2019 at our center. Patients were randomly allocated to a training (n=156) and validation set (n=68). In total, 2260 radiomics features were extracted from the arterial phase and portal venous phase of Gd-DTPA contrast-enhanced MRI. Using Max-Relevance and Min-Redundancy, random forest, least absolute shrinkage, and selection operator algorithm for dimensionality reduction, multivariable logistic regression was used to build the radiomics model. A clinical model and combined model were also established. The diagnostic performance of the models was compared. Results Eight radiomics features were chosen for the radiomics model, and four clinical factors (age, sex, HbsAg, and enhancement pattern) were chosen for the clinical model. A combined model was built using the factors from the previous models. The classification accuracy of the combined model differentiated HCC from FNH in both the training and validation sets (0.956 and 0.941, respectively). The area under the receiver operating characteristic curve of the combined model was significantly better than that of the clinical model for both the training (0.984 vs. 0.937, p=0.002) and validation (0.972 vs. 0.903, p=0.032) sets. Conclusions The combined model provided a non-invasive quantitative method for differentiating HCC from FNH in non-cirrhotic liver with high accuracy. Our model may assist clinicians in the clinical decision-making process.
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Affiliation(s)
- Zongren Ding
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Xihong Road 312, Fuzhou, 350025, China.,The Big Data Institute of Southeast Hepatobiliary Health Information, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China
| | - Kongying Lin
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Xihong Road 312, Fuzhou, 350025, China.,The Big Data Institute of Southeast Hepatobiliary Health Information, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China
| | - Jun Fu
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Xihong Road 312, Fuzhou, 350025, China.,The Big Data Institute of Southeast Hepatobiliary Health Information, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China
| | - Qizhen Huang
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Xihong Road 312, Fuzhou, 350025, China.,The Big Data Institute of Southeast Hepatobiliary Health Information, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China
| | - Guoxu Fang
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Xihong Road 312, Fuzhou, 350025, China.,The Big Data Institute of Southeast Hepatobiliary Health Information, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China
| | - Yanyan Tang
- Department of Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China
| | - Wuyi You
- Department of Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China
| | - Zhaowang Lin
- Department of Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China
| | - Zhan Lin
- Department of Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China
| | - Xingxi Pan
- Department of Oncology, Nanhai Hospital Affiliated to Southern Medical University, Foshan, 528000, China
| | - Yongyi Zeng
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Xihong Road 312, Fuzhou, 350025, China.
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Vahedifard F, Mortezazadeh M, Mofidi A, Kashani M, Sharifi Rayeni A. Focal nodular hyperplasia in a 14-year-old child: A case report. CASPIAN JOURNAL OF INTERNAL MEDICINE 2021; 12:S460-S463. [PMID: 34760105 PMCID: PMC8559645 DOI: 10.22088/cjim.12.0.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/27/2020] [Accepted: 01/09/2021] [Indexed: 10/31/2022]
Abstract
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-year-old 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.
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Affiliation(s)
| | - Masoud Mortezazadeh
- Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran,Correspondence: Masoud Mortezazadeh, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. E-mail: , Tel: 0098 2166559957, Fax: 0098 2166559957
| | - Abbas Mofidi
- Faculty of Medicine, Iran university of Medical Sciences, Tehran, Iran
| | - Mehdi Kashani
- Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Sharifi Rayeni
- Department of Gastroenterology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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7
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Diagnosis of Focal Nodular Hyperplasia (FNH) after Liver Transplantation. Case Rep Transplant 2020; 2020:8824099. [PMID: 33083085 PMCID: PMC7556100 DOI: 10.1155/2020/8824099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/09/2020] [Accepted: 09/17/2020] [Indexed: 11/29/2022] Open
Abstract
Following liver transplantation (LT), recipients can develop benign and malignant hepatic masses just like any other patient. Patients transplanted for hepatocellular carcinoma (HCC) undergo surveillance imaging, and any new mass seen on imaging must be carefully evaluated to rule out recurrent cancer. Focal nodular hyperplasia (FNH) is a benign tumor of the liver that most often occurs in women and is rarely symptomatic. It is important to distinguish FNH from more serious etiologies, such as recurrent HCC and other malignancies, since the treatments differ greatly. To date, there have been very few reports of FNH occurring in a liver allograft. We present a case of a patient with a history of a carcinoid tumor who underwent LT for HCC. Several years posttransplant, the patient was found to have a liver mass with classic features of HCC on imaging. The liver biopsy revealed the unexpected diagnosis of FNH. This finding avoided unnecessary treatment for HCC, which is associated with morbidity, especially in the posttransplant setting. We present our diagnostic approach, discuss the clinicopathologic and imaging findings of FNH, and review the literature on FNH in the posttransplant setting.
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Oldhafer KJ, Habbel V, Horling K, Makridis G, Wagner KC. Benign Liver Tumors. Visc Med 2020; 36:292-303. [PMID: 33005655 DOI: 10.1159/000509145] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/03/2020] [Indexed: 12/12/2022] Open
Abstract
Background Due to the frequent use of medical imaging including ultrasonography, the incidence of benign liver tumors has increased. There is a large variety of different solid benign liver tumors, of which hemangioma, focal nodular hyperplasia (FNH), and hepatocellular adenoma (HCA) are the most frequent. Advanced imaging techniques allow precise diagnosis in most of the patients, which reduces the need for biopsies only to limited cases. Patients with benign liver tumors are mostly asymptomatic and do not need any kind of treatment. Symptoms can be abdominal pain and pressure effects on adjacent structures. The 2 most serious complications are bleeding and malignant transformation. Summary This review focuses on hepatic hemangioma (HH), FNH, and HCA, and provides an overview on clinical presentations, surgical and interventional treatment, as well as conservative management. Treatment options for HHs, if indicated, include liver resection, radiofrequency ablation, and transarterial catheter embolization, and should be carefully weighed against possible complications. FNH is the most frequent benign liver tumor without any risk of malignant transformation, and treatment should only be restricted to symptomatic patients. HCA is associated with the use of oral contraceptives or other steroid medications. Unlike other benign liver tumors, HCA may be complicated by malignant transformation. HCAs have been divided into 6 subtypes based on molecular and pathological features with different risk of complication. Key Message The vast majority of benign liver tumors remain asymptomatic, do not increase in size, and rarely need treatment. Biopsies are usually not needed as accurate diagnosis can be obtained using modern imaging techniques.
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Affiliation(s)
- Karl J Oldhafer
- Department für Chirurgie, Klinik für Leber-, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek, Hamburg, Germany.,Semmelweis University Budapest, Asklepios Campus Hamburg, Hamburg, Germany
| | - Victoria Habbel
- Department für Chirurgie, Klinik für Leber-, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek, Hamburg, Germany.,Semmelweis University Budapest, Asklepios Campus Hamburg, Hamburg, Germany
| | | | - Georgios Makridis
- Department für Chirurgie, Klinik für Leber-, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek, Hamburg, Germany.,Semmelweis University Budapest, Asklepios Campus Hamburg, Hamburg, Germany
| | - Kim Caroline Wagner
- Department für Chirurgie, Klinik für Leber-, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek, Hamburg, Germany.,Semmelweis University Budapest, Asklepios Campus Hamburg, Hamburg, Germany
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Abstract
Focal nodular hyperplasia and hepatocellular adenoma are benign liver lesions that occur most frequently in women and may be found as incidental findings on imaging. hepatocellular adenomas may be infrequently associated with malignant progression or risk of rupture and as such, require surveillance or definitive treatments based on their size threshold. It is important clinically to differentiate these lesions, and utilizing imaging modalities such as contrast enhanced ultrasound or magnetic resonance imaging can be helpful in diagnosis. Further molecular subtyping of hepatocellular adenoma lesions may be beneficial to describe risk factors and potential future clinical complications.
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Affiliation(s)
- Lauren Myers
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, MNP 4112, Portland, OR 97239, USA.
| | - Joseph Ahn
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, MNP 4112, Portland, OR 97239, USA
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Hamada K, Saitoh S, Nishino N, Fukushima D, Techigawara K, Koyanagi R, Horikawa Y, Shiwa Y, Sakuma H, Kondo F. An elderly man with progressive focal nodular hyperplasia. Clin J Gastroenterol 2019; 13:413-420. [PMID: 31768882 PMCID: PMC7239834 DOI: 10.1007/s12328-019-01072-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/08/2019] [Indexed: 11/25/2022]
Abstract
Patients with focal nodular hyperplasia (FNH) develop benign hepatocellular nodules. FNH most frequently occurs in young women. There are no reports of the onset of FNH in elderly men. We report a case of FNH in an elderly man, whose nodules increased in number and size. The patient underwent surgery for carcinoma of the left renal pelvis at 69 years of age; no liver masses were noted on yearly follow-up contrast-enhanced computed tomography (CECT). Ten years later, CECT revealed a hepatic mass, and magnetic resonance imaging suggested FNH. The nodules increased in number and size in subsequent follow-up examinations.
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Affiliation(s)
- Koichi Hamada
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, 1 Hikariga-oka, Fukushima-shi, Fukushima, 960-1295, Japan. .,Department of Gastroenterology, Southern-Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama-shi, Fukushima, 963-8563, Japan.
| | - Satoshi Saitoh
- Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Noriyuki Nishino
- Department of Gastroenterology, Southern-Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama-shi, Fukushima, 963-8563, Japan
| | - Daizo Fukushima
- Department of Gastroenterology, Southern-Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama-shi, Fukushima, 963-8563, Japan
| | - Kae Techigawara
- Department of Gastroenterology, Southern-Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama-shi, Fukushima, 963-8563, Japan
| | - Ryota Koyanagi
- Department of Gastroenterology, Southern-Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama-shi, Fukushima, 963-8563, Japan
| | - Yoshinori Horikawa
- Department of Gastroenterology, Southern-Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama-shi, Fukushima, 963-8563, Japan
| | - Yoshiki Shiwa
- Department of Gastroenterology, Southern-Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama-shi, Fukushima, 963-8563, Japan
| | - Hideo Sakuma
- Department of Pathology, Southern-Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama-shi, Fukushima, 963-8563, Japan
| | - Fukuo Kondo
- Department of Pathology, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
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Tran Cao HS, Marcal LP, Mason MC, Yedururi S, Joechle K, Wei SH, Vauthey JN. Benign hepatic incidentalomas. Curr Probl Surg 2019; 56:100642. [DOI: 10.1067/j.cpsurg.2019.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/09/2019] [Indexed: 12/13/2022]
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13
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Holah NS, El-Azab DS, Aiad HAES, Sweed DMM. The Diagnostic Role of SPINK1 in Differentiating Hepatocellular Carcinoma From Nonmalignant Lesions. Appl Immunohistochem Mol Morphol 2018; 25:703-711. [PMID: 27028242 DOI: 10.1097/pai.0000000000000363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Distinction of small-sized hepatocellular carcinoma (HCC) from dysplastic nodules may be difficult. In addition, distinction of well-differentiated HCC (WD-HCC) from high-grade dysplastic nodule (HGDN) is also difficult in small needle biopsy. We aimed to study serine peptidase inhibitor, Kazal type 1 (SPINK1) immunohistochemical expression in HCC to differentiate it from nonmalignant lesions. METHODS This study included 179 specimens from the archival material of Pathology Department, National Liver Institute, Menoufia University, between 2007 and 2014, divided as 93 HCC and 86 nonmalignant lesions. All cases were stained for SPINK1 antibody. RESULTS SPINK1 was expressed in 76.3% of HCC cases with a diagnostic accuracy of 79.3%.There was a significant difference between focal nodular hyperplasia and WD-HCC cases regarding mean value of SPINK1 expression (P=0.015). In addition, there was low SPINK1 score in cirrhosis cases compared with WD-HCC. Moreover, there was a high significant difference between WD-HCC and HGDN regarding SPINK1 expression (P=0.001), with 83.3% sensitivity and 84.6% specificity. CONCLUSIONS SPINK1 can be used to differentiate between a WD-HCC and a HGDN with high diagnostic validity.
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Affiliation(s)
- Nanis S Holah
- Departments of *Pathology, Faculty of Medicine †Pathology, National Liver Institute, Menoufia University, Shebin El-Kom, Menoufia, Egypt
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Growth of Focal Nodular Hyperplasia is Not a Reason for Surgical Intervention, but Patients Should be Referred to a Tertiary Referral Centre. World J Surg 2018; 42:1506-1513. [PMID: 29167952 PMCID: PMC5895671 DOI: 10.1007/s00268-017-4335-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background When a liver lesion diagnosed as focal nodular hyperplasia (FNH) increases in size, it may cause doubt about the initial diagnosis. In many cases, additional investigations will follow to exclude hepatocellular adenoma or malignancy. This retrospective cohort study addresses the implications of growth of FNH for clinical management. Methods We included patients diagnosed with FNH based on ≥2 imaging modalities between 2002 and 2015. Characteristics of patients with growing FNH with sequential imaging in a 6-month interval were compared to non-growing FNH. Results Growth was reported in 19/162 (12%) patients, ranging from 21 to 200%. Resection was performed in 4/19 growing FNHs; histological examination confirmed FNH in all patients. In all 15 conservatively treated patients, additional imaging confirmed FNH diagnosis. No adverse outcomes were reported. No differences were found in characteristics and presentation of patients with growing or non-growing FNH. Conclusion This study confirms that FNH may grow significantly without causing symptoms. A significant increase in size should not have any implications on clinical management if confident diagnosis by imaging has been established by a tertiary benign liver multidisciplinary team. Liver biopsy is only indicated in case of doubt after state-of-the-art imaging. Resection is deemed unnecessary if the diagnosis is confirmed by multiple imaging modalities in a tertiary referral centre.
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Roux M, Pigneur F, Baranes L, Calderaro J, Chiaradia M, Decaens T, Kastahian S, Charles-Nelson A, Tselikas L, Costentin C, Laurent A, Azoulay D, Mallat A, Rahmouni A, Luciani A. Differentiating focal nodular hyperplasia from hepatocellular adenoma: Is hepatobiliary phase MRI (HBP-MRI) using linear gadolinium chelates always useful? Abdom Radiol (NY) 2018; 43:1670-1681. [PMID: 29110059 DOI: 10.1007/s00261-017-1377-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To assess the value of Hepatobiliary phase MRI (HPB-MRI) to differentiate FNH and HCA, and evaluate its impact on diagnostic accuracy, diagnostic confidence, inter-observer variability, and patient clinical management. METHODS Forty-nine patients referred for Gd-BOPTA-enhanced MRI were retrospectively included in this IRB-approved study, with a total of 119 lesions-90 FNH and 29 HCA. Two observers separately assessed in 2 distinct randomized reading sessions the performance of MRI with (HBP-MRI) or without (conventional MRI) the use of HBP images. Each lesion was ranked with a 5-point scale (from 1 Typical FNH to 5 Certainly not a FNH). Sensitivity, specificity, overall accuracy, and inter-observer agreement for the differentiation of FNH from HCA were calculated and compared between conventional and HBP-MRI. RESULTS Both sensitivity (respective values of 38.9% and 97.8%), overall accuracy (respective values of 53.8% and 98.3%), and inter-observer agreement (respective values of Kappa 0.56 and 0.88) were significantly higher using HBP-MRI than with conventional MRI, with unchanged specificity (100%). The sensitivity of conventional MRI for the diagnosis of FNH was significantly lower in lesions ≤ 3 cm (20% vs. 88%). Overall, HBP could have changed lesion management in 59/119 cases (49.5%), including 53 FNH and 6 HCA with no impact in 60/119 lesions (50.5%) including all 35 lesions classified as scores 1 and 2 for the diagnosis of FNH. CONCLUSIONS The clinical impact of HBP-MRI is mostly important for smaller than 3-cm FNH, and more limited in larger FNH lesions as well as for HCA diagnosis for which conventional MRI is already accurate. The use of extracellular contrast agents upfront could limit the required use of linear HBP contrast agents for benign hepatocellular lesion characterization. On HBP, all FNH appeared hypointense compared to adjacent liver while close to 97% of HCA appeared hypointense.
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Affiliation(s)
- Marion Roux
- Service de Radiodiagnostic et Radiologie interventionnelle, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Frederic Pigneur
- Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, AP-HP, 94010, Creteil, France
| | - Laurence Baranes
- Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, AP-HP, 94010, Creteil, France
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
| | - Julien Calderaro
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
- Groupe Henri Mondor Albert Chenevier, Pathology, AP-HP, 94010, Creteil, France
| | - Mélanie Chiaradia
- Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, AP-HP, 94010, Creteil, France
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
| | - Thomas Decaens
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
- Groupe Henri Mondor Albert Chenevier, Hepato-Gastroenterology Department, AP-HP, 94010, Creteil, France
| | - Sandrine Kastahian
- Groupe Henri Mondor Albert Chenevier, Unite de Recherche Clinique (URC), AP-HP, 94010, Creteil, France
| | - Anaïs Charles-Nelson
- Groupe Henri Mondor Albert Chenevier, Unite de Recherche Clinique (URC), AP-HP, 94010, Creteil, France
| | - Lambros Tselikas
- Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, AP-HP, 94010, Creteil, France
| | - Charlotte Costentin
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
- Groupe Henri Mondor Albert Chenevier, Hepato-Gastroenterology Department, AP-HP, 94010, Creteil, France
| | - Alexis Laurent
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
- Groupe Henri Mondor Albert Chenevier, Liver Surgery, AP-HP, 94010, Creteil, France
| | - Daniel Azoulay
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
- Groupe Henri Mondor Albert Chenevier, Liver Surgery, AP-HP, 94010, Creteil, France
| | - Ariane Mallat
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
- Groupe Henri Mondor Albert Chenevier, Hepato-Gastroenterology Department, AP-HP, 94010, Creteil, France
| | - Alain Rahmouni
- Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, AP-HP, 94010, Creteil, France
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
| | - Alain Luciani
- Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, AP-HP, 94010, Creteil, France
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
- INSERM Unite U 955, Equipe 18, 94010, Creteil, France
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16
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Naganuma H, Ishida H, Ogawa M, Watanabe Y, Watanabe D, Ohyama Y, Watanabe T. Focal nodular hyperplasia: our experience of 53 Japanese cases. J Med Ultrason (2001) 2016; 44:79-88. [PMID: 27550510 DOI: 10.1007/s10396-016-0734-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 07/07/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE Contrast-enhanced ultrasound (CEUS) is a very sensitive diagnostic tool in characterizing liver tumors. It is especially useful in the diagnosis of focal nodular hyperplasia (FNH) of the liver. According to the previous reports, FNH is common in young women, and it is usually diagnosed by MRI. The majority of the previous reports come from European countries, and a very few studies of large series designed to describe the clinical features in Japanese patients have been reported. The aim of this study was to (a) describe the clinical features in 53 patients (59 lesions) diagnosed with CEUS and (b) compare the data with those from the previous reports. METHODS The medical data from 53 patients diagnosed on the basis of typical CEUS findings at our institution and affiliated hospitals were reviewed, and their clinical data were analyzed. RESULTS (1) The medical data from 53 cases showed a slight male predilection, with 30 male cases (57 %) and 23 female cases (43 %), although the occurrence in both sexes was equal. FNH cases were distributed throughout all generations in both sexes, mostly concentrated in the age of 30-60 years old, and metabolic cases were more common in men than in women (4 vs 0). (2) The lesions were small (mean: 23 mm) and distributed throughout the whole liver. (3) Lesion size was not influenced by age in either sex. (4) A rapid draining to the hepatic vein was recognized in five out of 59 lesions (8 %). CONCLUSIONS Our data indicate that FNH occurs slightly more frequently in men than in women in Japan. It occurs also at any age in both sexes, but the mean lesion size was smaller in our series than in the previous reports. Metabolic disease was seen only in male FNH patients. A direct communication between the FNH lesion and the hepatic vein is diagnostically worth noting.
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Affiliation(s)
- Hiroko Naganuma
- Department of Gastroenterology, Yokote Municipal Hospital, Yokote, Japan.
| | - Hideaki Ishida
- Center of Diagnostic Ultrasound, Akita Red Cross Hospital, Akita, Japan
| | - Masahiro Ogawa
- Department of Gastroenterology and Hepatology, Nihon University Hospital, Tokyo, Japan
| | - Yukinobu Watanabe
- Department of Gastroenterology and Hepatology, Nihon University Hospital, Tokyo, Japan
| | - Daisuke Watanabe
- Department of Gastroenterology, Noshiro Ishikai Hospital, Noshiro, Japan
| | - Yoko Ohyama
- Department of Medical Laboratory, Akita Kousei Medical Center, Akita, Japan
| | - Takako Watanabe
- Center of Diagnostic Ultrasound, Akita Red Cross Hospital, Akita, Japan
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17
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Dioguardi Burgio M, Ronot M, Salvaggio G, Vilgrain V, Brancatelli G. Imaging of Hepatic Focal Nodular Hyperplasia: Pictorial Review and Diagnostic Strategy. Semin Ultrasound CT MR 2016; 37:511-524. [PMID: 27986170 DOI: 10.1053/j.sult.2016.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Focal nodular hyperplasia (FNH) is the second most common benign solid liver lesion after hemangioma, occurring more frequently in young women. The prime differential diagnoses include hepatocellular adenoma, hepatocellular carcinoma, and hypervascular metastasis. As the management of FNH is typically conservative, imaging plays a key role in diagnostic pathway, and misdiagnosis may have a major clinical effect. In this article, we describe the ultrasound, computed tomography, and magnetic resonance imaging features of FNH, underlining the importance of typical radiological features that allow a specific noninvasive diagnosis. We present a large spectrum of a typical imaging findings that FNH may present and discuss the up-to-date diagnostic strategy.
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Affiliation(s)
- Marco Dioguardi Burgio
- Radiology Department, Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP, Clichy, France
| | - Maxime Ronot
- Radiology Department, Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP, Clichy, France; University Paris Diderot, Sorbonne Paris Cité, INSERM UMR 1149, Paris, France
| | - Giuseppe Salvaggio
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies Di.Bi.Med., University of Palermo, Palermo, Italy
| | - Valérie Vilgrain
- Radiology Department, Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP, Clichy, France; University Paris Diderot, Sorbonne Paris Cité, INSERM UMR 1149, Paris, France
| | - Giuseppe Brancatelli
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies Di.Bi.Med., University of Palermo, Palermo, Italy.
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18
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Chandrasegaram MD, Shah A, Chen JW, Ruszkiewicz A, Astill DS, England G, Raju RS, Neo EL, Dolan PM, Tan CP, Brooke-Smith M, Wilson T, Padbury RTA, Worthley CS. Oestrogen hormone receptors in focal nodular hyperplasia. HPB (Oxford) 2015; 17:502-7. [PMID: 25728618 PMCID: PMC4430780 DOI: 10.1111/hpb.12387] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 12/13/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND The role of hormones in focal nodular hyperplasia (FNH) has been investigated with conflicting results. OBJECTIVE The aim of this study was to evaluate oestrogen and progesterone receptor immunohistochemical expression in FNH and surrounding normal liver (control material). METHODS Biopsy materials from FNH and control tissue were investigated using an immunostainer. Receptor expression was graded as the proportion score (percentage of nuclear staining) and oestrogen receptor intensity score. RESULTS Study material included tissue from 11 resected FNH lesions and two core biopsies in 13 patients (two male). Twelve samples showed oestrogen receptor expression. The percentage of nuclear oestrogen receptor staining was <33% in eight FNH biopsies, 34-66% in two FNH biopsies, and >67% in both core biopsies. The better staining in core biopsies relates to limitations of the staining technique imposed by the fibrous nature of larger resected FNH. Control samples from surrounding tissue were available for nine of the resected specimens and all showed oestrogen receptor expression. Progesterone receptor expression was negligible in FNH and control samples. CONCLUSIONS By contrast with previous studies, the majority of FNH and surrounding liver in this cohort demonstrated oestrogen receptor nuclear staining. The implications of this for continued oral contraceptive use in women of reproductive age with FNH remain uncertain given the lack of consistent reported growth response to oestrogen stimulation or withdrawal.
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Affiliation(s)
- Manju D Chandrasegaram
- Hepatobiliary Unit, Royal Adelaide HospitalAdelaide, SA, Australia,Division of Surgery, University of AdelaideAdelaide, SA, Australia,Correspondence Manju Chandrasegaram, Discipline of Surgery, School of Medicine, University of Adelaide, Adelaide, SA 5005, Australia. E-mail:
| | - Ali Shah
- Hepatobiliary Unit, Royal Adelaide HospitalAdelaide, SA, Australia
| | - John W Chen
- Hepatobiliary Unit, Royal Adelaide HospitalAdelaide, SA, Australia,Department of Surgery, Flinders Medical CentreAdelaide, SA, Australia
| | - Andrew Ruszkiewicz
- Department of Tissue Pathology, SA Pathology, Royal Adelaide Hospital SiteAdelaide, SA, Australia
| | - David S Astill
- Department of Tissue Pathology, SA Pathology, Flinders Medical Centre SiteAdelaide, SA, Australia
| | - Georgina England
- Department of Tissue Pathology, SA Pathology, Royal Adelaide Hospital SiteAdelaide, SA, Australia
| | - Ravish S Raju
- Department of Surgery, Flinders Medical CentreAdelaide, SA, Australia
| | - Eu Ling Neo
- Hepatobiliary Unit, Royal Adelaide HospitalAdelaide, SA, Australia,Department of Surgery, Flinders Medical CentreAdelaide, SA, Australia
| | - Paul M Dolan
- Hepatobiliary Unit, Royal Adelaide HospitalAdelaide, SA, Australia
| | - Chuan Ping Tan
- Hepatobiliary Unit, Royal Adelaide HospitalAdelaide, SA, Australia
| | - Mark Brooke-Smith
- Hepatobiliary Unit, Royal Adelaide HospitalAdelaide, SA, Australia,Department of Surgery, Flinders Medical CentreAdelaide, SA, Australia
| | - Tom Wilson
- Department of Surgery, Flinders Medical CentreAdelaide, SA, Australia
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19
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Roux M, Pigneur F, Calderaro J, Baranes L, Chiaradia M, Tselikas L, Decaens T, Costentin C, Laurent A, Azoulay D, Mallat A, Zafrani ES, Rahmouni A, Luciani A. Differentiation of focal nodular hyperplasia from hepatocellular adenoma: Role of the quantitative analysis of gadobenate dimeglumine-enhanced hepatobiliary phase MRI. J Magn Reson Imaging 2015; 42:1249-58. [PMID: 25851028 DOI: 10.1002/jmri.24897] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 03/11/2015] [Indexed: 01/23/2023] Open
Abstract
PURPOSE To determine the value of quantitative analysis of the hepatobiliary phase (HBP) in gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance imaging (MRI) to differentiate focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA). MATERIALS AND METHODS Thirty-eight patients bearing 67 lesions (40 FNH; 27 HCA) were retrospectively included in this Institutional Review Board-approved study. The same volumetric interpolated breath-hold examination (VIBE) T1 -weighted sequences were performed before and after contrast injection on a 1.5T MRI, with HBP images acquired with a mean delay of 80 minutes (range 60-120 min). After a visual assessment of lesions enhancement (qualitative HBP analysis), the HBP signal intensity ratio (SIR) and the lesion-to-liver contrast enhancement ratio (LLCER) were calculated for each lesion by two observers (Mann-Whitney test). The sensitivities, specificities (receiver operating characteristic [ROC] curve analysis) and interobserver correlation (intraclass coefficient, ICC) of quantitative HBP analysis were determined. RESULTS All FNH and 44.4% of HCA appeared hyper- or isointense relative to the adjacent liver on qualitative HBP analysis. The mean SIR (P < 0.01) and LLCER (P < 0.0001) of FNH were significantly higher than that of HCA. The area under the ROC curve for the differentiation of FNH from HCA with LLCER was 0.98 for both observers. With a cutoff value of -0.3%-observer 1 with highest experience- LLCER assessment provided respective sensitivity and specificity values of 100% and 96.2% for the differentiation of FNH from HCA. The ICC was 0.7 for SIR measurements and 0.8 for LLCER measurements. CONCLUSION Quantitative LLCER assessment allows an accurate differentiation of FNH from HCA, even in hyper- or isointense HCA on HBP images.
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Affiliation(s)
- Marion Roux
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France
| | - Frederic Pigneur
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France
| | - Julien Calderaro
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Pathology Department, Creteil, France
| | - Laurence Baranes
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France
| | - Mélanie Chiaradia
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France.,Paris Est Creteil University, Creteil, France
| | - Lambros Tselikas
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France
| | - Thomas Decaens
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Hepato-Gastroenterology Department, Creteil, France
| | - Charlotte Costentin
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Hepato-Gastroenterology Department, Creteil, France
| | - Alexis Laurent
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Liver Surgery Department, Creteil, France
| | - Daniel Azoulay
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Liver Surgery Department, Creteil, France
| | - Ariane Mallat
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Hepato-Gastroenterology Department, Creteil, France
| | - Elie-Serge Zafrani
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Pathology Department, Creteil, France
| | - Alain Rahmouni
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France.,Paris Est Creteil University, Creteil, France
| | - Alain Luciani
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France.,Paris Est Creteil University, Creteil, France.,INSERM Unite U 955, Equipe 17, Molecular Mechanisms of Liver Fibrosis, Creteil, France
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20
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Schwingel PA, Cotrim HP, Santos CRD, Santos AOD, Andrade ARCFD, Carruego MVVB, Zoppi CC. Recreational Anabolic-Androgenic Steroid Use Associated With Liver Injuries Among Brazilian Young Men. Subst Use Misuse 2015; 50:1490-8. [PMID: 26549387 DOI: 10.3109/10826084.2015.1018550] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The recreational use of anabolic-androgenic steroids (AAS) has reached alarming levels among healthy people. However, several complications have been related to consumption of these drugs, including liver disorders. OBJECTIVE To evaluate the prevalence of liver injuries in young Brazilian recreational AAS users. METHODS Between February/2007 and May/2012 asymptomatic bodybuilders who were ≥18 years old and reported AAS use for ≥6 months were enrolled. All had clinical evaluations, abdominal ultrasound (AUS), and blood tests. RESULTS 182 individuals were included in the study. The median age (interquartile range) was 26.0 years (22.0-30.0) and all were male. Elevated liver enzyme levels were observed in 38.5% (n = 70) of AAS users, and creatine phosphokinase was normal in 27.1% (n = 19) of them. Hepatic steatosis was observed by AUS in 12.1% of the sample. One individual had focal nodular hyperplasia and another had hepatocellular adenoma. One case each of hepatitis B and C virus infection was found. A diagnosis of toxic liver injury was suggested in 23 (12.6%) AAS users without a history of alcohol or other medications/drugs consumption, or evidence of other liver diseases. CONCLUSIONS/IMPORTANCE Young Brazilian recreational AAS users presented a wide spectrum of liver injuries that included hepatotoxicity, fatty liver, and liver neoplasm. They also presented risk factors for liver diseases such as alcohol consumption and hepatitis B and C virus infection. The results suggest that the risk of AAS use for the liver may be greater than the esthetic benefits, and demonstrate the importance of screening AAS users for liver injuries.
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Affiliation(s)
- Paulo Adriano Schwingel
- a Post-graduation Program in Medicine and Health , Universidade Federal da Bahia , Canela , Brazil
| | - Helma Pinchemel Cotrim
- a Post-graduation Program in Medicine and Health , Universidade Federal da Bahia , Canela , Brazil
| | | | | | | | | | - Cláudio Cesar Zoppi
- b Departamento de Biologia Estrutural e Funcional , Universidade Estadual de Campinas , Campinas , Brazil
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21
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Meng FY, Chen JM, Li Y. Diagnosis and treatment of focal nodular hyperplasia of the liver: Analysis of 176 cases. Shijie Huaren Xiaohua Zazhi 2014; 22:4333-4337. [DOI: 10.11569/wcjd.v22.i28.4333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinical manifestations, imaging characteristics and treatment of focal nodular hyperplasia (FNH) of the liver.
METHODS: One hundred and seventy-six patients with FNH of the liver treated from January 2000 to January 2014 were retrospectively reviewed. The clinical and imaging features and treatment strategies were analyzed.
RESULTS: Among the 176 patients, 105 were male and 71 were female, with an average age of 36.2 ± 12.0 years (range, 4-69 years). Approximately 7.9% of cases had clinical symptoms, and 92.1% had no symptoms. The difference between computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of FNH had statistical significance. In this series, 87 patients underwent hepatectomy, 59 underwent laparoscopic hepatectomy, 12 received radiofrequency ablation, and 18 received DSA therapy.
CONCLUSION: FNH of the liver has no typical symptoms. The combination of various imaging examinations can improve diagnosis. Compared with traditional surgery, laparoscopic hepatectomy is becoming more and more popular because of its minor trauma.
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22
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ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol 2014; 109:1328-47; quiz 1348. [PMID: 25135008 DOI: 10.1038/ajg.2014.213] [Citation(s) in RCA: 249] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 05/22/2014] [Indexed: 12/11/2022]
Abstract
Focal liver lesions (FLL) have been a common reason for consultation faced by gastroenterologists and hepatologists. The increasing and widespread use of imaging studies has led to an increase in detection of incidental FLL. It is important to consider not only malignant liver lesions, but also benign solid and cystic liver lesions such as hemangioma, focal nodular hyperplasia, hepatocellular adenoma, and hepatic cysts, in the differential diagnosis. In this ACG practice guideline, the authors provide an evidence-based approach to the diagnosis and management of FLL.
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23
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Tajiri K, Tsuneyama K, Kawai K, Atarashi Y, Minemura M, Sawada S, Tsukada K, Imura J, Sugiyama T. A case of progressing focal nodular hyperplasia and its molecular expression pattern. Clin J Gastroenterol 2014; 7:271-7. [PMID: 26183749 DOI: 10.1007/s12328-014-0483-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 03/23/2014] [Indexed: 02/05/2023]
Abstract
We report the case of an adult male with progressing focal nodular hyperplasia (FNH). Although imaging studies suggested that the tumor was a classical FNH, the tumor biopsy showed glutamine synthetase expression and heat shock protein 70 in part of the tumor. As we could not definitely distinguish this case of FNH from early hepatocellular carcinoma (HCC), we performed laparoscopic partial hepatectomy. The surgical resected specimen showed that the tumor had a central scar with vascular and cholangiolar proliferation, which is compatible with FNH. Immunohistochemical analysis showed that the molecular expression pattern was compatible with FNH in the center of the tumor, whereas it partly resembled early HCC in the periphery of the tumor. FNH progression is occasionally found, and the molecular pattern of the progressing area in FNH might resemble that of early HCC due to morphologic and phenotypic changes induced by the regenerative mechanism and the alteration of blood flow. We should carefully observe progressing FNH.
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Affiliation(s)
- Kazuto Tajiri
- Department of Gastroenterology, Toyama University Hospital, 2630 Sugitani, Toyama, 930-0194, Japan,
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24
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Augustine MM, Fong Y. Epidemiology and risk factors of biliary tract and primary liver tumors. Surg Oncol Clin N Am 2013; 23:171-88. [PMID: 24560105 DOI: 10.1016/j.soc.2013.10.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Primary liver and biliary tract tumors encompass a range of benign and malignant neoplasms. They consist of histologically distinct types of tumors that arise from and are influenced by hepatocytes, biliary epithelial cells, and mesenchymal cells. Improvements in imaging have allowed the detection and diagnosis of these neoplasms to be refined. Investigation at the histologic, molecular, and genetic levels has allowed neoplasms to be categorized and treated. Epidemiology has improved understanding of geographic, ethnic, gender, and cultural differences that link exposures with cancer risk. This article focuses on the epidemiology of major primary adult liver and biliary tract tumors.
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Affiliation(s)
- Mathew M Augustine
- Hepatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 353 East 68th Street, New York, NY 10065, USA
| | - Yuman Fong
- Hepatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 353 East 68th Street, New York, NY 10065, USA.
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25
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Bartolotta TV, Taibbi A, Brancatelli G, Matranga D, Tumbarello M, Midiri M, Lagalla R. Imaging findings of hepatic focal nodular hyperplasia in men and women: are they really different? Radiol Med 2013; 119:222-30. [PMID: 24297582 DOI: 10.1007/s11547-013-0333-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 05/13/2013] [Indexed: 12/17/2022]
Abstract
PURPOSE This study was undertaken to compare the imaging findings of focal nodular hyperplasia (FNH) in men and women, as seen on multidetector computed tomography (MDCT), magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS). MATERIALS AND METHODS Two radiologists reviewed 195 imaging studies (17 MDCT, 81 MRI and 97 CEUS examinations) pertaining to 111 FNHs (mean size 3 cm) in 91 patients (mean age 39 years). For each lesion, the readers assessed size, location, echogenicity, attenuation, or signal intensity in comparison with adjacent liver parenchyma on both unenhanced and postcontrast images. RESULTS Eighty-nine FNHs (mean size 3.1 cm) were observed in 73 women (mean age 37.9 years) and 22 FNHs (mean size 2.7 cm) in 18 men (mean age 41.2 years). No statistically significant differences were found between men and women in terms of age, FNH lesions per patient (1.22 and 1.21, respectively), size, baseline and enhancement pattern on MRI, CEUS and MDCT (p < 0.05). A central scar in FNHs was depicted in 4/18 (22.2%) men and 16/63 (25.4%) women on MRI (p < 0.05), and in 1/2 (50%) men and 7/15 (46.7%) women on MDCT (p < 0.05), whereas a spoke-wheel pattern, central scar, and/or feeding vessel were seen in 5/17 (29.4%) men and 22/80 (27.5%) women on CEUS (p < 0.05). CONCLUSIONS Our results did not show any differences in imaging features, age of occurrence and size of FNH between men and women.
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Baranes L, Chiaradia M, Pigneur F, Decaens T, Djabbari M, Zegaï B, Costentin C, Laurent A, Calderaro J, Rahmouni A, Luciani A. Imaging benign hepatocellular tumors: atypical forms and diagnostic traps. Diagn Interv Imaging 2013; 94:677-95. [PMID: 23830777 DOI: 10.1016/j.diii.2013.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Management of patients with a benign hepatocellular tumor relies largely on imaging data; the diagnosis of focal nodular hyperplasia (FNH) must be made with certainty using MRI, because no other clinical or laboratory data can help diagnosis. It is also essential to identify adenomas to manage them appropriately. The radiological report in these situations is therefore of major importance. However, there are diagnostic traps. The aim of this paper is to present the keys to the diagnosis of benign lesions and to warn of the main diagnostic pitfalls.
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Affiliation(s)
- L Baranes
- Medical imaging department, Henri-Mondor University Hospital, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
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27
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Focal nodular hyperplasia--a review of myths and truths. J Gastrointest Surg 2011; 15:2275-83. [PMID: 21959783 DOI: 10.1007/s11605-011-1680-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Accepted: 09/07/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Focal nodular hyperplasia (FNH) is a benign hyperplastic lesion of the liver with no known malignant potential. It has generated much interest due to the frequency with which it presents with atypical features on radiological imaging. Often resulting in misdiagnosis. Moreover, the understanding of particular subtypes of this lesion at a molecular level has changed in recent years. This may have implications on how certain subtypes should be managed. PURPOSE This review aims to analyse current literature pertaining to FNH and to provide clinically relevant advice regarding diagnosis and management.
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28
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Biologic and clinical features of benign solid and cystic lesions of the liver. Clin Gastroenterol Hepatol 2011; 9:547-62.e1-4. [PMID: 21397723 DOI: 10.1016/j.cgh.2011.03.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 02/24/2011] [Accepted: 03/02/2011] [Indexed: 02/07/2023]
Abstract
The widespread use of imaging analyses, either routinely or to evaluate symptomatic patients, has increased the detection of liver lesions (tumors and cysts) in otherwise healthy individuals. Although some of these incidentally discovered masses are malignant, most are benign and must be included in the differential diagnosis. The management of benign hepatic tumors ranges from conservative to aggressive, depending on the nature of the lesions. New imaging modalities, increased experience of radiologists, improved definition of radiologic characteristics, and a better understanding of the clinical features of these lesions have increased the accuracy of diagnoses and reduced the need for invasive diagnostic tests. These advances have led to constant adjustments in management approaches to benign hepatic lesions. We review the biologic and clinical features of some common hepatic lesions, to guide diagnosis and management strategies.
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Farruggia P, Alaggio R, Cardella F, Tropia S, Trizzino A, Ferrara F, D'Angelo P. Focal nodular hyperplasia of the liver: an unusual association with diabetes mellitus in a child and review of literature. Ital J Pediatr 2010; 36:41. [PMID: 20504362 PMCID: PMC2883986 DOI: 10.1186/1824-7288-36-41] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Accepted: 05/26/2010] [Indexed: 12/12/2022] Open
Abstract
Hepatic hemangioma, adenoma and focal nodular hyperplasia are the most frequent benign lesions of the liver, but they are all infrequent among pediatric population. The reports of focal nodular hyperplasia in children have recently increased in number, with many cases associated to drug intake, particularly to chemotherapy. We here describe, to our knowledge, the first case of focal nodular hyperplasia in association with diabetes mellitus in childhood.
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Affiliation(s)
- Piero Farruggia
- Unit of Pediatric Hematology and Oncology, G, Di Cristina Children's Hospital, and Department of Pediatrics, University of Palermo, Palermo, Italy.
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Ho CM, Lee PH. Atypical presentation of focal nodular hyperplasia. BMJ Case Rep 2010; 2010:bcr11.2009.2417. [PMID: 22242059 DOI: 10.1136/bcr.11.2009.2417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 27-year-old man, previously healthy, had an enlarging liver mass incidentally noted at a health check-up 6 months earlier. There were no known risk factors for hepatocellular carcinoma. The hepatic tumour seen on magnetic resonance imaging had characteristics of high T2 and low T1 signals, early hyper-enhancement and mild delayed enhancement, which was atypical for focal nodular hyperplasia (FNH). An atypical hepatectomy was performed smoothly and the pathologic confirmation of FNH was finally made. He was discharged without complications.
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Affiliation(s)
- Cheng-Maw Ho
- National Taiwan University Hospital, Department of Surgery, 7, Chun-Shan S. Road, Taipei, 100, Taiwan
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31
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Abstract
BACKGROUND With the routine use of improved imaging modalities, more benign liver lesions are detected nowadays. An accurate characterization of these incidental lesions may be a challenge, and frequently a biopsy or even unnecessary surgery is being performed. However, these interventions are not always to the benefit of the patient. METHODS A Medline search of studies relevant to imaging diagnosis and management of the most common, benign, solid and non-solid liver lesions was undertaken. References from identified articles were handsearched for further relevant articles. The authors' own experiences with benign liver lesions were also taken into account. RESULTS Although atypical imaging features are the exception rather than the rule, it is sometimes difficult to differentiate between benign and malignant lesions, and knowledge of their imaging features is essential if unnecessary work-up is to be avoided. The use of tissue-specific contrast media, which has clearly improved the accuracy of highly advanced radiological techniques, may be helpful during differential diagnosis. Once having established an accurate diagnosis, surgery is rarely indicated for a benign liver lesion because of its asymptomatic nature. CONCLUSION Knowledge of imaging features and a clear management strategy during diagnostic work-up, emphasizing the indications for surgery, will minimize the number of patients who have to undergo biopsy or unnecessary surgery.
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Affiliation(s)
- Türkan Terkivatan
- Department of Surgery, Erasmus University Medical Center Rotterdam, The Netherlands
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Wasif N, Sasu S, Conway WC, Bilchik A. Focal Nodular Hyperplasia: Report of an Unusual Case and Review of the Literature. Am Surg 2008. [DOI: 10.1177/000313480807401112] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Focal nodular hyperplasia (FNH) is the second most common benign lesion of the liver and a common differential in the workup of solid liver lesions. With increasing use of modern imaging modalities FNH is becoming clinically more relevant. We present a case of pedunculated FNH presenting as a pericholecystic mass. This was resected laparoscopically due to persistent symptoms and uncertainty in diagnosis. We summarize the current literature with regard to the diagnosis, etiology, and management of FNH lesions.
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Affiliation(s)
- Nabil Wasif
- Departments of Gastrointestinal Oncology and
| | - Sebastian Sasu
- Pathology, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
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Moya Herráiz Á, Torres-Quevedo R, Mir Pallardó J. Trasplante hepático en pacientes con lesiones hepáticas benignas. Cir Esp 2008; 84:60-6. [DOI: 10.1016/s0009-739x(08)72135-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Asbach P, Klessen C, Koch M, Hamm B, Taupitz M. Magnetic resonance imaging findings of atypical focal nodular hyperplasia of the liver. Clin Imaging 2007; 31:244-52. [PMID: 17599618 DOI: 10.1016/j.clinimag.2007.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 03/15/2007] [Indexed: 11/19/2022]
Abstract
Atypical focal nodular hyperplasia (FNH) of the liver is a diagnostic challenge as a variety of atypical imaging findings can occur in this entity. There is no potential for malignant transformation, making noninvasive diagnosis welcome in order to avoid invasive steps such as biopsy or surgery. The present pictorial review focuses on the atypical presentation of FNH and comments on different types of contrast media available for magnetic resonance imaging of the liver.
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Affiliation(s)
- Patrick Asbach
- Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, 10117 Berlin, Germany.
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Venturi A, Piscaglia F, Vidili G, Flori S, Righini R, Golfieri R, Bolondi L. Diagnosis and management of hepatic focal nodular hyperplasia. J Ultrasound 2007; 10:116-27. [PMID: 23396642 PMCID: PMC3478711 DOI: 10.1016/j.jus.2007.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Focal nodular hyperplasia (FNH) is the second most common benign tumor of the liver, after hemangioma. It is generally found incidentally and is most common in reproductive-aged women, but it also affects males and can be diagnosed at any age. Patients are rarely symptomatic, but FNH sometimes causes epigastric or right upper quadrant pain. The main clinical task is to differentiate it from other hypervascular hepatic lesions such as hepatic adenoma, hepatocellular carcinoma, or hypervascular metastases, but invasive diagnostic procedures can generally be avoided with the appropriate use of imaging techniques. Magnetic resonance (MR) imaging is more sensitive and specific than conventional ultrasonography (US) or computed tomography (CT), but Doppler US and contrast-enhanced US (CEUS) can greatly improve the accuracy in the diagnosis of FNH. Once a correct diagnosis has been made, in most cases there is no indication for surgery, and treatment includes conservative clinical follow-up in asymptomatic patients.
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Affiliation(s)
- A. Venturi
- Department of Internal Medicine and Gastroenterology, Policlinico St. Orsola-Malpighi, University of Bologna, Italy
| | - F. Piscaglia
- Department of Internal Medicine and Gastroenterology, Policlinico St. Orsola-Malpighi, University of Bologna, Italy
| | - G. Vidili
- Department of Internal Medicine and Gastroenterology, Policlinico St. Orsola-Malpighi, University of Bologna, Italy
| | - S. Flori
- Department of Internal Medicine and Gastroenterology, Policlinico St. Orsola-Malpighi, University of Bologna, Italy
| | - R. Righini
- Department of Internal Medicine and Gastroenterology, Policlinico St. Orsola-Malpighi, University of Bologna, Italy
| | - R. Golfieri
- Department of Radiology, Policlinico St. Orsola-Malpighi, University of Bologna, Italy
| | - L. Bolondi
- Department of Internal Medicine and Gastroenterology, Policlinico St. Orsola-Malpighi, University of Bologna, Italy
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Ibrahim S, Chen CL, Wang SH, Lin CC, Yang CH, Yong CC, Jawan B, Cheng YF. Liver resection for benign liver tumors: indications and outcome. Am J Surg 2007; 193:5-9. [PMID: 17188079 DOI: 10.1016/j.amjsurg.2006.04.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2005] [Revised: 04/17/2006] [Accepted: 04/17/2006] [Indexed: 12/14/2022]
Abstract
BACKGROUND The indications for intervention in cases of benign liver tumors include symptoms, suspicion of malignancy, or risk of malignant change. METHODS Eighty-four liver resections for benign tumors were performed in our hospital from June 1996 to December 2004. The patient records were reviewed retrospectively. RESULTS The study group (41 females, 43 males; average age, 41.4 +/- 10.5 y) included 46 cavernous hemangiomas, 27 focal nodular hyperplasias, 5 hepatic adenomas, and 6 liver cysts. The indications for resection were inability to rule out malignancy (50 [59.5%]), symptoms (33 [39.3%]), and others (1 [1.2%]). Postoperatively, 28 of the 33 patients had resolution of symptoms. Twenty-nine patients (34.5%) had chronic hepatitis B infection. CONCLUSIONS Liver resection for benign liver tumor is safe, but indications for intervention must be evaluated carefully. The presence of chronic parenchymal liver disease does not increase morbidity in these patients.
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Affiliation(s)
- Salleh Ibrahim
- Department of Surgery and Liver Transplantation Program, Chang Gung Memorial Hospital-Kaohsiung Medical Center, and Chang Gung University College of Medicine, 123 Ta-Pei Rd., Niao-Sung, Kaohsiung 83305, Taiwan
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Bonney GK, Gomez D, Al-Mukhtar A, Toogood GJ, Lodge JPA, Prasad R. Indication for treatment and long-term outcome of focal nodular hyperplasia. HPB (Oxford) 2007; 9:368-72. [PMID: 18345321 PMCID: PMC2225515 DOI: 10.1080/13651820701504173] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Unlike malignant liver tumours, the indications for hepatic resection for benign disease are not well defined. This is particularly true for focal nodular hyperplasia (FNH). Here we summarize a single-centre experience of the diagnosis and management of FNH. MATERIALS AND METHODS Using a prospectively collected database, a retrospective analysis of consecutive patients who were managed at our centre for FNH between January 1997 and December 2006 was performed. RESULTS The cohort was divided into two groups of patients: those who were managed surgically (n=15) and those managed conservatively (n=37). There was no correlation between tumour size and number of lesions with oral contraceptive use (p=0.07 and 0.90, respectively) and pregnancy (p=0.45 and 0.60, respectively). However, tumour size (p=0.006) and number of lesions (p=0.02) were associated with the occurrence of pain in these patients. Pain was the commonest symptom of patients (13/15) who were managed surgically. All patients underwent radiological imaging before diagnosis. The sensitivities of ultrasound, CT scanning and MRI scanning in characterizing these lesions were 30%, 70% and 87%, respectively. There were no postoperative deaths and three postoperative complications that were successfully managed non-operatively. With a median follow-up of 24 months in the surgically treated group, one patient has developed recurrent symptoms of pain. CONCLUSION. In this series, there was no mortality directly due to the surgical procedure and a modest morbidity, justifying surgical resections in selected patients.
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Affiliation(s)
- Glenn K. Bonney
- Department of Hepatobiliary and Transplantation Surgery, St James’ University, Hospital, Leeds Teaching Hospitals TrustLeedsUK
| | - Dhanwant Gomez
- Department of Hepatobiliary and Transplantation Surgery, St James’ University, Hospital, Leeds Teaching Hospitals TrustLeedsUK
| | - Ahmed Al-Mukhtar
- Department of Hepatobiliary and Transplantation Surgery, St James’ University, Hospital, Leeds Teaching Hospitals TrustLeedsUK
| | - Giles J. Toogood
- Department of Hepatobiliary and Transplantation Surgery, St James’ University, Hospital, Leeds Teaching Hospitals TrustLeedsUK
| | - J. Peter A. Lodge
- Department of Hepatobiliary and Transplantation Surgery, St James’ University, Hospital, Leeds Teaching Hospitals TrustLeedsUK
| | - Raj Prasad
- Department of Hepatobiliary and Transplantation Surgery, St James’ University, Hospital, Leeds Teaching Hospitals TrustLeedsUK
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Abstract
Nonmalignant liver masses are increasingly being recognized with the widespread use of imaging modalities such as ultrasonography, computed tomography, and magnetic resonance imaging. The majority of these lesions are detected incidentally in asymptomatic patients. Based on the radiologic appearance, benign lesions can be categorized as solid or cystic, single or multiple, hypervascular or hypovascular. Based on histologic characteristics, they are classified as of hepatocellular, biliary, or mesenchymal origin. In the majority of patients, a proper diagnosis can be made based on these characteristics on imaging modalities alone. An invasive approach is seldom required. This review discusses the various characteristics of the most common benign liver lesions and recommends a practical approach.
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Affiliation(s)
- Wojciech Blonski
- Department of Medicine, Division of Gastroenterology, 3 Ravdin Building, Hospital of the University of Pennsylvania, Philadelphia, PA 19014, USA
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39
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Vilgrain V. Focal nodular hyperplasia. Eur J Radiol 2006; 58:236-45. [PMID: 16414229 DOI: 10.1016/j.ejrad.2005.11.043] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Revised: 11/25/2005] [Accepted: 11/29/2005] [Indexed: 01/06/2023]
Abstract
Focal nodular hyperplasia is the second most common benign liver tumor after hemangioma and occurs predominantly in young women. Imaging techniques are crucial in the diagnosis of this lesion. In this article, we will present the imaging findings of the classic and non-classic FNHs. The role of percutaneous biopsy will also be detailed.
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Affiliation(s)
- Valérie Vilgrain
- Department of Radiology, Hôpital Beaujon, 100 Bd du Général Leclerc, 92110 Clichy, France.
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