Focal nodular hyperplasia: a case report and literature review
DOI:
https://doi.org/10.5281/zenodo.5792071Keywords:
focal nodular hyperplasia, oral contraceptives, occupational medicine, rehabilitation, surgery, liverAbstract
Focal nodular hyperplasia (FNH) is a rare benign hepatic tumor that originates from epithelial tissue and composed mainly of hepatocytes and Kupffer cells. It is usually present as an asymptomatic abdominal mass and is typically an incidental diagnosis because majority of patients lack symptoms. Symptoms are more frequent in women using contraceptive steroids. It must be distinguished from other more common benign and malignant lesions because of different therapeutic approaches. It occurs in all age groups, but more than 50 % of the patients are women between 25 and 44 years.
The etiology of this condition remains obscure. Various causes have been proposed for FNH, including localized ischemic injury related to vascular anomaly, vascular injury such as thrombosis and induction of hepatocellular proliferation by oral contraceptive steroid ingestion (OC). The standard treatment of FNH is to manage asymptomatic lesions conservatively and operative resection of symptomatic ones.
We present the clinical course as well as the clinicopathologic implication of a 20-year-old female adolescent with FNH who wasn’t OC users and review this rare hepatic lesion in the literature.
References
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2. Benz EJ, Baggenstoss AH. Focal crrhosis of the liver; Its relation to the so-called hamartoma (adenoma, benign hepatoma). Cancer 1953;6:743-755.
3. Kay S, Talbert PC. Adenoma of the liver, mixed type (hamartoma); Report of two cases. Cancer 1950;3:307-315.
4. Seibert JJ, Soper RT. Preoperative diagnosis of benign hepatic hamartoma by correlation radioisotopic and angiographic studies. Pediatr Radiol 1976;4:149-152.
5. Gerding WJ, Popp MF, Martineau PC. Hamartomatous cholangiohepatoma: Report of a case. JAMA 1951;145:821-822.
6. Patton RJ. Hamartoma of the liver. Ann Surg 1948;127:180-186.
7. Hertzer NR, Hawk WA, Hermann RE. Inflammatory lesions of the liver which stimulate the tumor: Report of two cases in children. Surgery 1971;69:839-846.
8. Garancis JC, Tang T, Panares R, Jurevics I. Hepatic adenoma: Biochemical and electron microscopic study. Cancer 1969;24:560-568.
9. Edmondson HA. Tumors of the liver and intrahepatic bile ducts. In: Atlas of Tumor Pathology, sect. 7, fasc. 25. Washngton, DC.: Armed Forces Institute of Pathology, 1958.
10. Gibson JB, Sobin LH. Histological Typing of Tumours of the Liver, Biliary Tract, and Pancreas. Geneva: World Health Organization, 1978.
11. Leevy CM, Popper H, Sherlock S. Disease of the Liver and Biliary Tract, Standardization of Nomenclature, Diagnostic Criteria, and Diagnostic Methodology. Fogarty International Center Proceedings, no.22. Washington D.C.: U.S. Government Printing Office, 1976:1-212.
12. Yoshihiko F, Osmanu N, Akiko K, et al. Angioarchitecture and blood circulation in focal nodular hyperplasia of the liver. J Hepatol 1998; 29:470-475.
13. Mays ET, Christopherson WM, Barrows GH. Focal nodular hyperplasia of the liver: possible relationship to oral contraceptives. Am J Clin Pathol 1974;61:735-46.
14. Stauffer JQ, Lapinski MW, Honold DJ, Myers JK. Focal nodular hyperplasia of the liver and intrahepatic hemorrhage in young women on oral contraceptives. Ann Intern Med 1975;83:301-6.
15. Knowles DM, Wolff M. Focal nodular hyperplasia of the liver: a clinicopathologic study and review of the literature. Hum Pathol 1976;7:533-45.
16. Travers H, D’Amato NA. Vascular alterations in focal nodular hyperplasia of the liver. Mil Med 1978;2:96-101.
17. Stocker JT, Ishak KG. Focal nodular hyperplasia of the liver: a study of 21 pediatric cases. Cancer 1981;48:336-45.
18. Wanless IR, Mawdsley C, Adams R. On the pathogenesis of focal nodular hyperplasia of the liver. Hepatology 1985;5:1194-200.
19. Kimka N, Zachary D, Resa L et al. Hemangiomas with Localized Nodular Proliferation of the Liver. Am J Surg Pathol 1990;14:142-150.
20. Didier M, Hicham K, Patrick M, Alain R, et al. Oral contraceptive use and focal nodular hyperplasia of the Liver. Gastroenterology 2000;118:560-564.
21. Whelan JJ, Baugh JH, Chandor S. Focal nodular hyperplasia of the liver. Ann Surg 1973;177:150-8.
22. Lough J, Kinch R, Spellman S, Shaffer E. Oral contraceptives, smoking, and nodular hyperplasia of the liver. Can Med Assoc J 1978;118:403-4.
23. Nissen EP, Kent DR. Liver tumors and oral contraceptives. Obstet Gynecol 1975;46:460-7.
24. Stauffer JQ, Lapinski MW, Honold DJ, Myers JK. Focal nodular hyperplasia of the liver and intrahepatic hemorrhage in young females on oral contraceptives. Ann Int Med 1975;83:301-6.
25. Cherqui D, Rahmouni A, Charlotte F et al. Management of focal nodular hyperplasia and hepatocellular adenoma in young women: a series of 41 patients with clinical, radiological, and pathological correlations. Hepatology 1995;22:1674-1681.
26. Weimann A, Ringe B, Klempnauer J, et al. Benign liver tumors: differential diagnosis and indications for surgery. World J Surg 1997;21:983-991.
27. Baum JK, Holtz F, Bookstein JJ et al. Possible association between benign hepatomas and oral contraceptives. Lancet 1973;2:926-929.
28. Pain JA, Gimson AE, Williams R, Howard ER. Focal nodular hyperplasia of the liver: results of treatment and options in manegement. Gut 1991;32:524-527.
29. Thomas S, Kamal G. Focal nodular hyperplasia of the liver: a study of 21 pediatric cases. Cancer 1981;48:336-345.
30. Reymond D, Plaschkes A, Ridolfi K, Leinbundgut A, et al. Focal nodular hyperplasia of the liver in children: review of follow-up and outcome. J Pediatr Surg 1995;30:1590-1593.
31. Lough J, Spicer P, Kinch R. Focal nodular hyperplasia of the liver: An electron microscopic study of the vascular lesions. Hum Pathol 1980;11:181-186.
32. Evans JE, Dick R, Scherlock S. Focal nodular hyperplasia of the liver. Br J Surg 1980;67:175-7.
33. Somech R, Brazowski E, Kesller A, et al. Focal nodular hyperplasia in children. J Pediatr Gastroent Nutr 2001;32:480-3.
34. Greenberg M, Filler RM: Hepatic tumors, in Pizzo PA, Poplack DG (eds): Principles and Practice of Pediatric Oncology. Philadelpjia, PA, Lippincott, 1989,pp 569-582.
35. Iwatsuki S, Toto S, Startzl TE. Excisional therapy for the benign hepatic lesions. Surg. Gynecol. Obstet. 1990;171:240-.
36. Ishak KG, Rabin L. Benign tumors of the liver. Med Clin North Am 1975;59:995-.
37. Belghiti J, Pateron D, Panis Y, et al. Resection of presumed benign liver tumours. Br J Surg 1993;80:380-
38. Knowles DM, Casarella WJ, Johnson PM, Wolff M. The clinical, radiologic, and pathologic characterization of benign hepatic neoplasms. Medicine (Baltimore) 1978;57:223-
39. Everson RB, Museles M, Henson DE, Grundy GW. Focal nodular hyperplasia of the liver in a child with hemihypertrophy. J Pediatr 1976;88:985-987.
40. Goldstein HM, Neiman HL, Mona E, Bookstein JJ, Appelman HD. Angiographic findings in benign liver cell tumors. Diagnost Radiol 1974;110:339-343.
41. Colle I, de Beeck BO, Hoorens A, Hautekeete M. Multiple focal nodular hyperplasia. J Gastroenterol 1998;33:904-8.
42. Fechner RE. Benign hepatic lesions and orally administered contraceptices. Hum Pathol 1977;8:255-268.
43. Nime F, Picken JW, Vana J, et al. The histology of liver tumors in oral contraceptive users observed during a national survey by the American College of Surgeons Commission on Cancer. Cancer 1979;44:1481-1489.
44. Ross D, Pina J, Mirza M, et al. Regression of focal nodular hyperplasia after discontinuation of oral contraceptives. Ann Intern Med 1976;85:203-204.
45. Aldinger K, Ben-Menachem A, Whalen G. A case of focal nodular hyperplasia of the liver associated with high-dose estrogens. Arch Intern Med 1977;137:357-359.
46. Klatskin G. Hepatic tumors: possible relationship to use of oral contraceptives. Gastroenterology 1997;73:386-94.
47. Goodman ZD, Ishak KG. Hepatocellular carcinoma in women: Probable lack of etiologic association with oral contraceptive steroids. Hepatology 1982;2:440-444.
48. O’Sullivan JP. Oral contraceptives and liver tumors. Proc R Soc Med 1976;69:351-353.
49. Christopherson WM, Mays ET, Barrows G. A clinicopathologic study of steroid-related liver tumors. Am J Surg Pathol 1977;1:31-41.
50. Hytiroglou P, Theise ND. Differential diagnosis of hepatocellular nodular lesions. Semin Diag Pathol 1998;15:285-99.
51. David M. Benign hepatic tumors: focal nodular hyperplasia and hepatocellular adenoma. World J Surg 1995;19:13-18.
52. Kerlin P, Davis G, McGill D, et al. Hepatic adenoma and focal nodular hyperplasia: clinical, pathologic and radiologic features. Gastroenterology 1983;84:994-
53. Mathieu D, Zafrani ES, Anglade M et al. Association of focal nodular hyperplasia and hepatic hemangioma. Gastroenterology 1989;97:154-
54. Friedman LS, Gang D, Hedberg SE, et al. Simultaneous occurrence of hepatic adenoma and focal nodular hyperplasia: report of a case and review of the literature. Hepatology 1984;4:536-
55. Nguyen BN, Flejou JF, Terris B. Focal nodular hyperplasia of the liver: aa comprehensive pathologic study of 305 lesions and recognition of new histologic forms. Am J Surg Pathl 1999;23:1441-54.
56. Mowat AP, Gutjahr P, Portmann B, et al. Focal nodular hyperplasia of the liver: A rational approach to treatment. Gut 1976;17:492-494.
57. Oliff S, Karani J, Thomas S, et al. Superselective embolization using coaxial catheter technique. Br J Radiol 1990;63:197-201.
58. Soucy P, Carpenter B, Chou S, et al. Definitive treatment of focal nodular hyperplasia of the liver by ethanol embolization. J Pediatr Surg 1989;24:1095-1097.
59. Scott LD, Katz AR, Duke JH, et al. Oral contraceptives, pregnancy, and focal nodular hyperplasia of the liver. J.A.M.A. 1984;251:1461-
60. Mays ET, Christopherson W. Hepatic tumors induced by sex steroids. Semin Liver Dis 1984;4:147-
61. Muguti G, Tait N, Richardson A, et al: Hepatic focal nodular hyperplasia: A benign incidentaloma or a marker of serious hepatic disease? HPB Surg 1992;5:171-180.
2. Benz EJ, Baggenstoss AH. Focal crrhosis of the liver; Its relation to the so-called hamartoma (adenoma, benign hepatoma). Cancer 1953;6:743-755.
3. Kay S, Talbert PC. Adenoma of the liver, mixed type (hamartoma); Report of two cases. Cancer 1950;3:307-315.
4. Seibert JJ, Soper RT. Preoperative diagnosis of benign hepatic hamartoma by correlation radioisotopic and angiographic studies. Pediatr Radiol 1976;4:149-152.
5. Gerding WJ, Popp MF, Martineau PC. Hamartomatous cholangiohepatoma: Report of a case. JAMA 1951;145:821-822.
6. Patton RJ. Hamartoma of the liver. Ann Surg 1948;127:180-186.
7. Hertzer NR, Hawk WA, Hermann RE. Inflammatory lesions of the liver which stimulate the tumor: Report of two cases in children. Surgery 1971;69:839-846.
8. Garancis JC, Tang T, Panares R, Jurevics I. Hepatic adenoma: Biochemical and electron microscopic study. Cancer 1969;24:560-568.
9. Edmondson HA. Tumors of the liver and intrahepatic bile ducts. In: Atlas of Tumor Pathology, sect. 7, fasc. 25. Washngton, DC.: Armed Forces Institute of Pathology, 1958.
10. Gibson JB, Sobin LH. Histological Typing of Tumours of the Liver, Biliary Tract, and Pancreas. Geneva: World Health Organization, 1978.
11. Leevy CM, Popper H, Sherlock S. Disease of the Liver and Biliary Tract, Standardization of Nomenclature, Diagnostic Criteria, and Diagnostic Methodology. Fogarty International Center Proceedings, no.22. Washington D.C.: U.S. Government Printing Office, 1976:1-212.
12. Yoshihiko F, Osmanu N, Akiko K, et al. Angioarchitecture and blood circulation in focal nodular hyperplasia of the liver. J Hepatol 1998; 29:470-475.
13. Mays ET, Christopherson WM, Barrows GH. Focal nodular hyperplasia of the liver: possible relationship to oral contraceptives. Am J Clin Pathol 1974;61:735-46.
14. Stauffer JQ, Lapinski MW, Honold DJ, Myers JK. Focal nodular hyperplasia of the liver and intrahepatic hemorrhage in young women on oral contraceptives. Ann Intern Med 1975;83:301-6.
15. Knowles DM, Wolff M. Focal nodular hyperplasia of the liver: a clinicopathologic study and review of the literature. Hum Pathol 1976;7:533-45.
16. Travers H, D’Amato NA. Vascular alterations in focal nodular hyperplasia of the liver. Mil Med 1978;2:96-101.
17. Stocker JT, Ishak KG. Focal nodular hyperplasia of the liver: a study of 21 pediatric cases. Cancer 1981;48:336-45.
18. Wanless IR, Mawdsley C, Adams R. On the pathogenesis of focal nodular hyperplasia of the liver. Hepatology 1985;5:1194-200.
19. Kimka N, Zachary D, Resa L et al. Hemangiomas with Localized Nodular Proliferation of the Liver. Am J Surg Pathol 1990;14:142-150.
20. Didier M, Hicham K, Patrick M, Alain R, et al. Oral contraceptive use and focal nodular hyperplasia of the Liver. Gastroenterology 2000;118:560-564.
21. Whelan JJ, Baugh JH, Chandor S. Focal nodular hyperplasia of the liver. Ann Surg 1973;177:150-8.
22. Lough J, Kinch R, Spellman S, Shaffer E. Oral contraceptives, smoking, and nodular hyperplasia of the liver. Can Med Assoc J 1978;118:403-4.
23. Nissen EP, Kent DR. Liver tumors and oral contraceptives. Obstet Gynecol 1975;46:460-7.
24. Stauffer JQ, Lapinski MW, Honold DJ, Myers JK. Focal nodular hyperplasia of the liver and intrahepatic hemorrhage in young females on oral contraceptives. Ann Int Med 1975;83:301-6.
25. Cherqui D, Rahmouni A, Charlotte F et al. Management of focal nodular hyperplasia and hepatocellular adenoma in young women: a series of 41 patients with clinical, radiological, and pathological correlations. Hepatology 1995;22:1674-1681.
26. Weimann A, Ringe B, Klempnauer J, et al. Benign liver tumors: differential diagnosis and indications for surgery. World J Surg 1997;21:983-991.
27. Baum JK, Holtz F, Bookstein JJ et al. Possible association between benign hepatomas and oral contraceptives. Lancet 1973;2:926-929.
28. Pain JA, Gimson AE, Williams R, Howard ER. Focal nodular hyperplasia of the liver: results of treatment and options in manegement. Gut 1991;32:524-527.
29. Thomas S, Kamal G. Focal nodular hyperplasia of the liver: a study of 21 pediatric cases. Cancer 1981;48:336-345.
30. Reymond D, Plaschkes A, Ridolfi K, Leinbundgut A, et al. Focal nodular hyperplasia of the liver in children: review of follow-up and outcome. J Pediatr Surg 1995;30:1590-1593.
31. Lough J, Spicer P, Kinch R. Focal nodular hyperplasia of the liver: An electron microscopic study of the vascular lesions. Hum Pathol 1980;11:181-186.
32. Evans JE, Dick R, Scherlock S. Focal nodular hyperplasia of the liver. Br J Surg 1980;67:175-7.
33. Somech R, Brazowski E, Kesller A, et al. Focal nodular hyperplasia in children. J Pediatr Gastroent Nutr 2001;32:480-3.
34. Greenberg M, Filler RM: Hepatic tumors, in Pizzo PA, Poplack DG (eds): Principles and Practice of Pediatric Oncology. Philadelpjia, PA, Lippincott, 1989,pp 569-582.
35. Iwatsuki S, Toto S, Startzl TE. Excisional therapy for the benign hepatic lesions. Surg. Gynecol. Obstet. 1990;171:240-.
36. Ishak KG, Rabin L. Benign tumors of the liver. Med Clin North Am 1975;59:995-.
37. Belghiti J, Pateron D, Panis Y, et al. Resection of presumed benign liver tumours. Br J Surg 1993;80:380-
38. Knowles DM, Casarella WJ, Johnson PM, Wolff M. The clinical, radiologic, and pathologic characterization of benign hepatic neoplasms. Medicine (Baltimore) 1978;57:223-
39. Everson RB, Museles M, Henson DE, Grundy GW. Focal nodular hyperplasia of the liver in a child with hemihypertrophy. J Pediatr 1976;88:985-987.
40. Goldstein HM, Neiman HL, Mona E, Bookstein JJ, Appelman HD. Angiographic findings in benign liver cell tumors. Diagnost Radiol 1974;110:339-343.
41. Colle I, de Beeck BO, Hoorens A, Hautekeete M. Multiple focal nodular hyperplasia. J Gastroenterol 1998;33:904-8.
42. Fechner RE. Benign hepatic lesions and orally administered contraceptices. Hum Pathol 1977;8:255-268.
43. Nime F, Picken JW, Vana J, et al. The histology of liver tumors in oral contraceptive users observed during a national survey by the American College of Surgeons Commission on Cancer. Cancer 1979;44:1481-1489.
44. Ross D, Pina J, Mirza M, et al. Regression of focal nodular hyperplasia after discontinuation of oral contraceptives. Ann Intern Med 1976;85:203-204.
45. Aldinger K, Ben-Menachem A, Whalen G. A case of focal nodular hyperplasia of the liver associated with high-dose estrogens. Arch Intern Med 1977;137:357-359.
46. Klatskin G. Hepatic tumors: possible relationship to use of oral contraceptives. Gastroenterology 1997;73:386-94.
47. Goodman ZD, Ishak KG. Hepatocellular carcinoma in women: Probable lack of etiologic association with oral contraceptive steroids. Hepatology 1982;2:440-444.
48. O’Sullivan JP. Oral contraceptives and liver tumors. Proc R Soc Med 1976;69:351-353.
49. Christopherson WM, Mays ET, Barrows G. A clinicopathologic study of steroid-related liver tumors. Am J Surg Pathol 1977;1:31-41.
50. Hytiroglou P, Theise ND. Differential diagnosis of hepatocellular nodular lesions. Semin Diag Pathol 1998;15:285-99.
51. David M. Benign hepatic tumors: focal nodular hyperplasia and hepatocellular adenoma. World J Surg 1995;19:13-18.
52. Kerlin P, Davis G, McGill D, et al. Hepatic adenoma and focal nodular hyperplasia: clinical, pathologic and radiologic features. Gastroenterology 1983;84:994-
53. Mathieu D, Zafrani ES, Anglade M et al. Association of focal nodular hyperplasia and hepatic hemangioma. Gastroenterology 1989;97:154-
54. Friedman LS, Gang D, Hedberg SE, et al. Simultaneous occurrence of hepatic adenoma and focal nodular hyperplasia: report of a case and review of the literature. Hepatology 1984;4:536-
55. Nguyen BN, Flejou JF, Terris B. Focal nodular hyperplasia of the liver: aa comprehensive pathologic study of 305 lesions and recognition of new histologic forms. Am J Surg Pathl 1999;23:1441-54.
56. Mowat AP, Gutjahr P, Portmann B, et al. Focal nodular hyperplasia of the liver: A rational approach to treatment. Gut 1976;17:492-494.
57. Oliff S, Karani J, Thomas S, et al. Superselective embolization using coaxial catheter technique. Br J Radiol 1990;63:197-201.
58. Soucy P, Carpenter B, Chou S, et al. Definitive treatment of focal nodular hyperplasia of the liver by ethanol embolization. J Pediatr Surg 1989;24:1095-1097.
59. Scott LD, Katz AR, Duke JH, et al. Oral contraceptives, pregnancy, and focal nodular hyperplasia of the liver. J.A.M.A. 1984;251:1461-
60. Mays ET, Christopherson W. Hepatic tumors induced by sex steroids. Semin Liver Dis 1984;4:147-
61. Muguti G, Tait N, Richardson A, et al: Hepatic focal nodular hyperplasia: A benign incidentaloma or a marker of serious hepatic disease? HPB Surg 1992;5:171-180.
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2017-12-19
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Kopljar, M., Škeva, G., Milostić-Srb, A., Žiger, T., & Madžar, Z. (2017). Focal nodular hyperplasia: a case report and literature review. BioMedicine and Surgery, 1(4), 162–166. https://doi.org/10.5281/zenodo.5792071
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Copyright (c) 2021 Mario Kopljar, Doc. dr. sc., Goranka Škeva, Andrea Milostić-Srb, Doc. dr. sc., Tihomil Žiger, Prof. dr. sc.
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