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Focal Nodular Hyperplasia

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Evaluation and Management of Liver Masses

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Abstract

Focal nodular hyperplasia is a focal proliferation of benign hepatocytes within the liver. These primary liver masses are relatively common and are often discovered incidentally in asymptomatic patients. Comprehensive radiologic evaluation will provide a confident diagnosis of this benign entity in most patients. When radiologic evaluation is inconclusive, characteristic histopathologic findings at biopsy can confirm the diagnosis. No treatment is needed for the vast majority of cases. In a symptomatic patient, surgical resection and percutaneous ablation are both viable options for therapy.

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References

  1. Brenard R, Chapaux X, Deltenre P, Henrion J, De Maeght S, Horsmans Y, et al. Large spectrum of liver vascular lesions including high prevalence of focal nodular hyperplasia in patients with hereditary haemorrhagic telangiectasia: the Belgian Registry based on 30 patients. Eur J Gastroenterol Hepatol. 2010;22(10):1253–9.

    CAS  PubMed  Google Scholar 

  2. Buscarini E, Danesino C, Plauchu H, de Fazio C, Olivieri C, Brambilla G, et al. High prevalence of hepatic focal nodular hyperplasia in subjects with hereditary hemorrhagic telangiectasia. Ultrasound Med Biol. 2004;30(9):1089–97.

    PubMed  Google Scholar 

  3. Wanless IR, Albrecht S, Bilbao J, Frei JV, Heathcote EJ, Roberts EA, et al. Multiple focal nodular hyperplasia of the liver associated with vascular malformations of various organs and neoplasia of the brain: a new syndrome. Mod Pathol. 1989;2(5):456–62.

    CAS  PubMed  Google Scholar 

  4. Wanless IR, Mawdsley C, Adams R. On the pathogenesis of focal nodular hyperplasia of the liver. Hepatology. 1985;5(6):1194–200.

    CAS  PubMed  Google Scholar 

  5. Furlan A, Brancatelli G, Dioguardi Burgio M, Grazioli L, Lee JM, Murmura E, et al. Focal nodular hyperplasia after treatment with oxaliplatin: a multiinstitutional series of cases diagnosed at MRI. AJR Am J Roentgenol. 2018;210(4):775–9.

    PubMed  Google Scholar 

  6. Joyner BL Jr, Levin TL, Goyal RK, Newman B. Focal nodular hyperplasia of the liver: a sequela of tumor therapy. Pediatr Radiol. 2005;35(12):1234–9.

    PubMed  Google Scholar 

  7. Sempoux C, Balabaud C, Paradis V, Bioulac-Sage P. Hepatocellular nodules in vascular liver diseases. Virchows Arch. 2018;473(1):33–44.

    PubMed  Google Scholar 

  8. Kaltenbach TE, Engler P, Kratzer W, Oeztuerk S, Seufferlein T, Haenle MM, et al. Prevalence of benign focal liver lesions: ultrasound investigation of 45,319 hospital patients. Abdom Radiol (NY). 2016;41(1):25–32.

    PubMed  PubMed Central  Google Scholar 

  9. Karhunen PJ. Benign hepatic tumours and tumour like conditions in men. J Clin Pathol. 1986;39(2):183–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Vilgrain V, Uzan F, Brancatelli G, Federle MP, Zappa M, Menu Y. Prevalence of hepatic hemangioma in patients with focal nodular hyperplasia: MR imaging analysis. Radiology. 2003;229(1):75–9.

    PubMed  Google Scholar 

  11. Horta G, Lopez M, Dotte A, Cordero J, Chesta C, Castro A, et al. Benign focal liver lesions detected by computed tomography: review of 1,184 examinations. Rev Med Chil. 2015;143(2):197–202.

    PubMed  Google Scholar 

  12. Nguyen BN, Flejou JF, Terris B, Belghiti J, Degott C. Focal nodular hyperplasia of the liver: a comprehensive pathologic study of 305 lesions and recognition of new histologic forms. Am J Surg Pathol. 1999;23(12):1441–54.

    CAS  PubMed  Google Scholar 

  13. Busireddy KK, Ramalho M, AlObaidy M, Matos AP, Burke LM, Dale BM, et al. Multiple focal nodular hyperplasia: MRI features. Clin Imaging. 2018;49:89–96.

    PubMed  Google Scholar 

  14. Luciani A, Kobeiter H, Maison P, Cherqui D, Zafrani ES, Dhumeaux D, et al. Focal nodular hyperplasia of the liver in men: is presentation the same in men and women? Gut. 2002;50(6):877–80.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Rebouissou S, Couchy G, Libbrecht L, Balabaud C, Imbeaud S, Auffray C, et al. The beta-catenin pathway is activated in focal nodular hyperplasia but not in cirrhotic FNH-like nodules. J Hepatol. 2008;49(1):61–71.

    CAS  PubMed  Google Scholar 

  16. Cha DI, Yoo SY, Kim JH, Jeon TY, Eo H. Clinical and imaging features of focal nodular hyperplasia in children. AJR Am J Roentgenol. 2014;202(5):960–5.

    PubMed  Google Scholar 

  17. Venturi A, Piscaglia F, Vidili G, Flori S, Righini R, Golfieri R, et al. Diagnosis and management of hepatic focal nodular hyperplasia. J Ultrasound. 2007;10(3):116–27.

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Bertin C, Egels S, Wagner M, Huynh-Charlier I, Vilgrain V, Lucidarme O. Contrast-enhanced ultrasound of focal nodular hyperplasia: a matter of size. Eur Radiol. 2014;24(10):2561–71.

    PubMed  Google Scholar 

  19. Kim TK, Jang HJ, Burns PN, Murphy-Lavallee J, Wilson SR. Focal nodular hyperplasia and hepatic adenoma: differentiation with low-mechanical-index contrast-enhanced sonography. AJR Am J Roentgenol. 2008;190(1):58–66.

    PubMed  Google Scholar 

  20. Venkatesh SK, Hennedige T, Johnson GB, Hough DM, Fletcher JG. Imaging patterns and focal lesions in fatty liver: a pictorial review. Abdom Radiol (NY). 2017;42(5):1374–92.

    Google Scholar 

  21. Yoo SY, Kim JH, Eo H, Jeon TY, Sung KW, Kim HS. Dynamic MRI findings and clinical features of benign hypervascular hepatic nodules in childhood-cancer survivors. AJR Am J Roentgenol. 2013;201(1):178–84.

    PubMed  Google Scholar 

  22. Mortele KJ, Praet M, Van Vlierberghe H, Kunnen M, Ros PR. CT and MR imaging findings in focal nodular hyperplasia of the liver: radiologic-pathologic correlation. AJR Am J Roentgenol. 2000;175(3):687–92.

    CAS  PubMed  Google Scholar 

  23. Brancatelli G, Federle MP, Grazioli L, Blachar A, Peterson MS, Thaete L. Focal nodular hyperplasia: CT findings with emphasis on multiphasic helical CT in 78 patients. Radiology. 2001;219(1):61–8.

    CAS  PubMed  Google Scholar 

  24. Ganeshan D, Szklaruk J, Kundra V, Kaseb A, Rashid A, Elsayes KM. Imaging features of fibrolamellar hepatocellular carcinoma. AJR Am J Roentgenol. 2014;202(3):544–52.

    PubMed  Google Scholar 

  25. Mattison GR, Glazer GM, Quint LE, Francis IR, Bree RL, Ensminger WD. MR imaging of hepatic focal nodular hyperplasia: characterization and distinction from primary malignant hepatic tumors. AJR Am J Roentgenol. 1987;148(4):711–5.

    CAS  PubMed  Google Scholar 

  26. Choi BY, Nguyen MH. The diagnosis and management of benign hepatic tumors. J Clin Gastroenterol. 2005;39(5):401–12.

    PubMed  Google Scholar 

  27. Choi CS, Freeny PC. Triphasic helical CT of hepatic focal nodular hyperplasia: incidence of atypical findings. AJR Am J Roentgenol. 1998;170(2):391–5.

    CAS  PubMed  Google Scholar 

  28. Yoneda N, Matsui O, Kitao A, Kozaka K, Kobayashi S, Sasaki M, et al. Benign hepatocellular nodules: hepatobiliary phase of gadoxetic acid-enhanced MR imaging based on molecular background. Radiographics. 2016;36(7):2010–27.

    PubMed  Google Scholar 

  29. Zech CJ, Grazioli L, Breuer J, Reiser MF, Schoenberg SO. Diagnostic performance and description of morphological features of focal nodular hyperplasia in Gd-EOB-DTPA-enhanced liver magnetic resonance imaging: results of a multicenter trial. Investig Radiol. 2008;43(7):504–11.

    Google Scholar 

  30. Grazioli L, Bondioni MP, Haradome H, Motosugi U, Tinti R, Frittoli B, et al. Hepatocellular adenoma and focal nodular hyperplasia: value of gadoxetic acid-enhanced MR imaging in differential diagnosis. Radiology. 2012;262(2):520–9.

    PubMed  Google Scholar 

  31. Mohajer K, Frydrychowicz A, Robbins JB, Loeffler AG, Reed TD, Reeder SB. Characterization of hepatic adenoma and focal nodular hyperplasia with gadoxetic acid. J Magn Reson Imaging. 2012;36(3):686–96.

    PubMed  PubMed Central  Google Scholar 

  32. Ronot M, Paradis V, Duran R, Kerbaol A, Vullierme MP, Belghiti J, et al. MR findings of steatotic focal nodular hyperplasia and comparison with other fatty tumours. Eur Radiol. 2013;23(4):914–23.

    PubMed  Google Scholar 

  33. Mettler FA, Guiberteau MJ. Essentials of nuclear medicine imaging. 5th ed. Philadelphia: Saunders/Elsevier; 2006. xi, 577 p. p.

    Google Scholar 

  34. Ziessman HA, O'Malley JP, Thrall JH. Nuclear medicine : the requisites in radiology. 3rd ed. Philadelphia: Mosby Elsevier; 2006. xii, 580 p., 16 p. of plates p.

    Google Scholar 

  35. Wells ML, Hough DM, Fidler JL, Kamath PS, Poterucha JT, Venkatesh SK. Benign nodules in post-Fontan livers can show imaging features considered diagnostic for hepatocellular carcinoma. Abdom Radiol (NY). 2017;42:2623.

    Google Scholar 

  36. Makhlouf HR, Abdul-Al HM, Goodman ZD. Diagnosis of focal nodular hyperplasia of the liver by needle biopsy. Hum Pathol. 2005;36(11):1210–6.

    PubMed  Google Scholar 

  37. Chandan VS, Shah SS, Mounajjed T, Torbenson MS, Wu TT. Copper deposition in focal nodular hyperplasia and inflammatory hepatocellular adenoma. J Clin Pathol. 2018;71(6):504–7.

    CAS  PubMed  Google Scholar 

  38. Joseph NM, Ferrell LD, Jain D, Torbenson MS, Wu TT, Yeh MM, et al. Diagnostic utility and limitations of glutamine synthetase and serum amyloid-associated protein immunohistochemistry in the distinction of focal nodular hyperplasia and inflammatory hepatocellular adenoma. Mod Pathol. 2014;27(1):62–72.

    CAS  PubMed  Google Scholar 

  39. Deniz K, Moreira RK, Yeh MM, Ferrell LD. Steatohepatitis-like changes in focal nodular hyperplasia, a finding to distinguish from steatohepatitic variant of hepatocellular carcinoma. Am J Surg Pathol. 2017;41(2):277–81.

    PubMed  Google Scholar 

  40. Perrakis A, Demir R, Muller V, Mulsow J, Aydin U, Alibek S, et al. Management of the focal nodular hyperplasia of the liver: evaluation of the surgical treatment comparing with observation only. Am J Surg. 2012;204(5):689–96.

    PubMed  Google Scholar 

  41. Hedayati P, VanSonnenberg E, Shamos R, Gillespie T, McMullen W. Treatment of symptomatic focal nodular hyperplasia with percutaneous radiofrequency ablation. J Vasc Interv Radiol. 2010;21(4):582–5.

    PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Michael L. Wells

  2. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA

    Rondell P. Graham

  3. Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Douglas A. Simonetto

Authors
  1. Michael L. Wells
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  2. Rondell P. Graham
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  3. Douglas A. Simonetto
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Corresponding author

Correspondence to Michael L. Wells .

Editor information

Editors and Affiliations

  1. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Lewis R. Roberts

  2. Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Ju Dong Yang

  3. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Sudhakar K. Venkatesh

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Wells, M.L., Graham, R.P., Simonetto, D.A. (2020). Focal Nodular Hyperplasia. In: Roberts, L., Yang, J., Venkatesh, S. (eds) Evaluation and Management of Liver Masses. Springer, Cham. https://doi.org/10.1007/978-3-030-46699-2_6

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  • DOI: https://doi.org/10.1007/978-3-030-46699-2_6

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-46698-5

  • Online ISBN: 978-3-030-46699-2

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