World Journal of Surgery

, Volume 19, Issue 1, pp 13–18

Benign hepatic tumors: Focal nodular hyperplasia and hepatocellular adenoma

  • David M. Nagorney
Article

Abstract

Focal nodular hyperplasia (FNH) and hepatocellular adenoma (HA) are uncommon benign hepatic tumors that continue to pose diagnostic and therapeutic challenges. An update of a recent Mayo Clinic experience is presented to highlight the management of patients harboring these neoplasms. A marked female predominance was seen. Incidental diagnosis was more prevalent with FNH, whereas symptomatic presentation was typical of HA. The frequency of oral contraceptive steroid use was similar regardless of tumor histology. Preoperative diagnosis remains difficult. Scintigraphy proved most specific, and ultrasonography and computed tomography were equally sensitive. Resection was employed in most patients. There was no mortality and minimal morbidity. Selective observation of FNH was uneventful, but resolution of HA after abstinence of oral contraceptive steroids was uncommon. These findings and data from the literature support selective management of benign liver tumors.

Résumé

L'hyperplasie focale nodulaire (HFN) et l'adénome hépatocellulaire (AH) sont deux tumeurs peu fréquentes qui continuent de poser un challenge diagnostique et thérapeutique. L'expérience de la clinique Mayo a été revue afin de souligner les problèmes thérapeutiques soulevés par ces tumeurs. Il y avait plus de femmes que d'hommes. Le diagnostic fortuit était plutôt le fait des HFN alors que les AH étaient plus souvent symptomatiques. Des antécédents de prise de contraceptifs ont été retrouvés dans les deux cas. Le diagnostic préopératoire reste problématique. La scintigraphie est l'examen le plus spécifique alors que l'échographie et la tomodensitométrie sont également sensibles. La résection a été effectuée chez la plupart des patients. Il n'y avait aucune mortalité et la morbidité était minime. La surveillance dans HNF est possible mais la plupart des AH ne régressent pas à l'arrêt des contraceptifs. Ces données et celles de la littérature sont en faveur d'un traitement sélectif de ces tumeurs hépatiques bénignes.

Resumen

La hiperplasia focal nodular (FNH) y el adenoma hepatocelular (HA) son tumores hepáticos benignos poco comunes que presentan problemas diagnósticos y de orden terapéutico. Se presenta una actualización de una experiencia reciente de la Clínica Mayo con el propósito de relievar el manejo de los pacientes que albergan tales neoplasias. Se observó una marcada predominancia en el sexo femenino. El diagnóstico incidental fue más común con la FNH y la presentación sintomática fue típica de HA. La frecuencia en cuanto al uso de agentes anticonceptivos esteroideos orales fue similar sin distinción en lo referente a la histología del tumor. El diagnóstico preoperatorio sigue siendo dificil. La escintigrafia demostró ser el método más específico, y la ultrasonografía y la tomografía computadorizada demostraron ser igualmente sensibles. Se practicó resección en la mayoría de los pacientes, sin mortalidad y con mínima morbilidad. La observación selectiva de la FNH estuvo libre de problemas, pero la resolución del HA luego de abstinencia de agentes anticonceptivos esterorideos orales fue poco común. Estos hallazgos y los datos extraídos de la literatura apoyan la política de un manejo selectivo de los tumores benignos del hígado.

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Copyright information

© Société Internationale de Chirurgie 1995

Authors and Affiliations

  • David M. Nagorney
    • 1
  1. 1.Department of SurgeryMayo Clinic and Mayo FoundationRochesterU.S.A.

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