Surgical indications for focal nodular hyperplasia of the liver: Single-center experience of 48 adult cases

Outcomes of transarterial embolization for large symptomatic focal nodular hyperplasia in 17 pediatric patients

BACKGROUND

To evaluate the safety and the long-term outcomes of transarterial embolization (TAE) with lipiodol-bleomycin emulsion (LBE) plus N-Butyl cyanoacrylate (NBCA) in the treatment of children with large symptomatic focal nodular hyperplasia (FNH).

METHODS

This is a retrospective case serial study. Children (aged <18 years) with FNH were treated. Indications for TAE were patients who were presenting with FNH related abdominal pain and the maximum diameter of FNH is more than 7 cm, and who were not candidates for surgical treatment. Technical success, adverse events, symptoms relief rate, and changes in the lesion size after TAE were evaluated.

RESULTS

Between January 2003 and February 2018, 17 pediatric patients were included. Technical success was achieved in all patients. Mean follow-up was 67.5 months. All patients had complete resolution of abdominal symptom. The mean largest diameter of the lesions decreased from 10.5 cm to 1.9 cm (P < 0.01). The mean volume reduction rate was 96.9%. The complete resolution of the FNH was observed in 16 patients. No further therapy was needed for all patients.

CONCLUSIONS

TAE with LBE plus NBCA appears to be a safe and effective treatment in pediatric patients with large symptomatic FNH. It could be considered as the first-line treatment for symptomatic large FNH.

Ultrasound-guided thermal ablation versus laparoscopic surgery for focal nodular hyperplasia of the liver: A retrospective controlled study

Purpose

This study aims to evaluate the value of the clinical application of ultrasound-guided percutaneous thermal ablation in focal nodular hyperplasia (FNH) by comparing its safety, effectiveness, and patient experience to surgery in the treatment of hepatic FNH ≤5 cm.

Method

This retrospective study enrolled 82 patients with hepatic FNH having a maximum diameter of ≤5 cm, confirmed by postoperative pathologic diagnosis or needle biopsy, who underwent thermal ablation or surgery between January 2019 and September 2021. Postoperative efficacy, surgical trauma (operation time, intraoperative bleeding volume, liver function, and lost volume of normal liver tissue), postoperative complications (postoperative infection, pleural effusion, and liver dysfunction), patient experience (degree and time of postoperative pain, postoperative fasting time, indwelling thoracic chest drain, and scar size), and economic indices (postoperative hospitalization and total charges) were compared between both groups.

Result

No significant difference existed in postoperative efficacy between both groups (p > 0.05). No recurrent or new lesions were observed during the 6-month follow-up in both groups. However, significant differences were observed in operation time, intraoperative bleeding volume, and lost volume of normal liver tissue (p < 0.05), with significantly less trauma in the thermal ablation group. No statistically significant differences in ALT, AST, and Hb existed between both groups (p > 0.05); however, albumin was higher in the ablation group compared to the surgery group (38.21 ± 3.32 vs. 34.84 ± 3.71 g/L, p < 0.05), and WBC were lower in the ablation group (11.91 ± 3.37 vs. 13.94 ± 3.65/L, p < 0.05). The incidence of postoperative complications in the ablation group was significantly lower than that in the surgery group (p < 0.05). Patient experiences were significantly better than in the surgical group (p < 0.05), with economic indicators being significantly less in the ablation group (p < 0.05).

Conclusion

Ultrasound-guided percutaneous thermal ablation can treat hepatic FNH ≤5 cm with similar clinical efficacy as surgery and is an economical, safe, and minimally invasive treatment method worthy of recommendation.

Long-term outcomes of transarterial embolization with lipiodol-bleomycin emulsion plus polyvinyl alcohol particles versus the particles alone for large symptomatic focal nodular hyperplasia: a propensity score-matched analysis

OBJECTIVES

To compare the efficacy of transarterial embolization (TAE) with polyvinyl alcohol (PVA) particles alone and lipiodol-bleomycin emulsion (LBE) plus PVA particles for patients with unresectable large symptomatic focal nodular hyperplasia (FNH).

METHODS

We performed a retrospective analysis of patients who underwent TAE either with PVA particles alone (group A, n = 46) or LBE plus PVA particles (group B, n = 35) for large (≥ 7 cm) symptomatic FNH between January 2002 and February 2019. Propensity score matching (PSM) (1:1) was performed to adjust for potential baseline confounders. Technical success, adverse events (AEs), symptom relief, and changes in the lesion size after TAE were evaluated. Statistical analysis included Wilcoxon rank sum test and χ² test.

RESULTS

After PSM, no significant differences in baseline characteristics were found between the groups (31 in group A and 31 in group B, with a mean age of 31 years). Technical success was achieved in all patients (100%), without major AEs in both groups. Complete resolution of the abdominal symptoms was reported in 77.4% in group A and 100% in group B (p = 0.037) during a mean follow-up period of 72 months; complete resolution (CR) of the FNH rate was significantly higher in group B than in group A (93.6% vs. 67.7%; p = 0.019).

CONCLUSION

Compared with the use PVA particles alone, TAE with LBE plus PVA particles in the treatment of patients with large symptomatic FNH had a significantly higher rates of CR of the FNH and complete relief of the symptoms.

KEY POINTS

• Transarterial embolization (TAE) with lipiodol-bleomycin emulsion (LBE) plus PVA particles for the large symptomatic FNH yielded better results than with PVA particles alone, in terms of complete resolution of FNH lesions (93.6% vs 67.7%) and complete relief of the abdominal symptoms (100% vs 77.4%) during a mean follow-up period of 72 months (38-170 months). • No major complications were recorded in both groups, and no significant difference in the incidence of postembolization syndrome were observed between the two groups.

Ultrasound-Guided Percutaneous Thermal Ablation of Hepatic Focal Nodular Hyperplasia--A Multicenter Retrospective Study

Background and Aim: To evaluate the clinical effect of ultrasound (US)-guided percutaneous thermal ablation of hepatic focal nodular hyperplasia (FNH). Methods: A retrospective analysis of the clinical data of patients undergoing US-guided percutaneous thermal ablation of FNH from November 2008 to August 2021 at five medical centers in China was conducted. Results: A total of 53 patients were included (26 males and 27 females). The mean age was 35.1 ± 10.8 years. Sixty-five lesions (46 solitary cases and 7 cases with multiple lesions) were included, 70.8% (46/65) of which were located in the right liver lobe. The mean tumor length was 2.9 ± 1.5 cm. All patients successfully completed the ablation treatment. Immediate postoperative imaging showed that the primary technical success rate was 94.3% (50/53). Two patients underwent ablation 3 and 6 months after the primary ablation, and the secondary technical success rate was 100% (2/2). The incidence of complications was 3.8% (2/53). Imaging follow-up was conducted regularly after ablation, and no residual lesion enlargement or tumor recurrence was observed during the follow-up period. The technique efficacy rate was 98.1% (52/53). Conclusion: US-guided percutaneous thermal ablation is a safe and effective treatment for FNH of the liver.

Large focal nodular hyperplasia is unresponsive to arterial embolization: A case report

BACKGROUND

Focal nodular hyperplasia (FNH) commonly occurs in women; it is usually asymptomatic and sometimes difficult to differentiate from hepatocellular carcinoma (HCC).

CASE SUMMARY

A large space-occupying lesion in the right lobe of the liver was incidentally detected in an adult man and diagnosed as HCC. Transcatheter arterial chemoembolization was applied once monthly for 2 years, but the lesion did not decrease in size. It was revealed by biopsy to be FNH. Eleven years later, the patient underwent liver resection due to hemorrhage and the pathological examination confirmed FNH.

CONCLUSION

For a space-occupying lesion, it is prerequisite to pathologically confirm the diagnosis and the corresponding intervention can be effective.

Focal nodular hyperplasia associated with a giant hepatocellular adenoma: A case report and review of literature

BACKGROUND

Focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) are well-known benign liver lesions. Surgical treatment is usually chosen for symptomatic patients, lesions more than 5 cm, and uncertainty of diagnosis.

CASE SUMMARY

We described the case of a large liver composite tumor in an asymptomatic 34-year-old female under oral contraceptive for 17-years. The imaging work-out described two components in this liver tumor; measuring 6 cm × 6 cm and 14 cm × 12 cm × 6 cm. The multidisciplinary team suggested surgery for this young woman with an unclear HCA diagnosis. She underwent a laparoscopic left liver lobectomy, with an uneventful postoperative course. Final pathological examination confirmed FNH associated with a large HCA. This manuscript aimed to make a literature review of the current management in this particular situation of large simultaneous benign liver tumors.

CONCLUSION

The simultaneous presence of benign composite liver tumors is rare. This case highlights the management in a multidisciplinary team setting.

Focal nodular hyperplasia mimicking hepatocellular adenoma and carcinoma in two cases

Focal nodular hyperplasia (FNH) is a solid benign tumor of the liver, predominantly in young women. A correct diagnosis of FNH is essential for making appropriate clinical decisions and avoiding unnecessary liver resection. Herein, we reported that two male cases with FNH, who initially presented with persistent abdominal discomfort, were misdiagnosed with hepatocellular adenoma (HCA) and hepatocellular carcinoma (HCC) on contrast-enhanced magnetic resonance imaging and computed tomography scans, respectively. After surgery, a histological diagnosis of FNH was finally established. In this paper, we also reviewed the knowledge regarding diagnosis and differential diagnosis of FNH on imaging examinations, which are helpful for avoiding misdiagnoses and guiding clinical interventions.