Focal nodular hyperplasia

Focal nodular hyperplasia
Micrograph of focal nodular hyperplasia. H&E stain.
Classification and external resources
DiseasesDB	33467
eMedicine	radio/286
MeSH	D020518

Focal nodular hyperplasia (FNH) is a benign tumor of the liver (hepatic tumor), which is the second most prevalent tumor of the liver (the first is hepatic hemangioma). It is usually asymptomatic, rarely grows or bleeds, and has no malignant potential. This tumour was once often resected because it was difficult to distinguish from hepatic adenoma, but with modern multiphase imaging is usually now diagnosed by strict imaging criteria and not resected.

Presentation

Ultrasound of malformed vessels within the fibrous scar of FNH.

Focal nodular hyperplasia's most recognizable gross feature is a central stellate scar seen in 60–70% of cases. Microscopically, a lobular proliferation of bland-appearing hepatocytes with a bile ductular proliferation and malformed vessels within the fibrous scar is the most common pattern. Other patterns include telangiectatic, hyperplastic-adenomatous, and lesions with focal large-cell dysplasia.^[1] Rarely, these lesions may be multiple or can occur as part of a syndrome with hemangiomas, epithelioid hemangioendothelioma, hepatic adenomas, fibrolamellar hepatocellular carcinoma, vascular malformations of the brain, meningiomas, and/or astrocytomas.^[1]

Patophysiology

FNH is not a true neoplasm; it is believed to result from localized hyperplastic hepatocyte response to an underlying congenital arteriovenous malformation. It consists of normal liver constituents in an abnormally organized pattern, grows in a stellate pattern and may display central necrosis when large.^[2] Additionally evidence suggests that the incidence of FNH is related to oral contraceptive use.^[3]

Notes

1. Nguyen, Bich N.; Fléjou, Jean-François; Terris, Benoit; Belghiti, Jacques; Degott, Claude (1999). "Focal Nodular Hyperplasia of the Liver". The American Journal of Surgical Pathology. 23 (12): 1441–54. doi:10.1097/00000478-199912000-00001. PMID 10584697.
2. Imaging in Focal Nodular Hyperplasia at eMedicine
3. Scalori, Astrid; Tavani, Alessandra; Gallus, Silvano; La Vecchia, Carlo; Colombo, Massimo (2002). "Oral contraceptives and the risk of focal nodular hyperplasia of the liver: A case-control study". American Journal of Obstetrics and Gynecology. 186 (2): 195–7. doi:10.1067/mob.[phone]. PMID 11854634.

References

• Chun Hsee, Li; McCall, John L.; Koea, Jonathan B. (2005). "Focal nodular hyperplasia: what are the indications for resection?". HPB. 7 (4): 298–302. doi:10.1080/13651820500273624. PMC 2043107. PMID 18333211.