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A case of focal nodular hyperplasia with hepatic failure treated with liver transplantation

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Abstract

Focal nodular hyperplasia (FNH) is a benign nodular lesion, but because of its feature of portal tract vessel abnormality, it may induce portal hypertension. A 27-year-old woman was admitted with a fever. A large nodule with satellite lesions was found in the liver and cotton wool-like feature of arteries were detected on angiography. Technetium galactosyl serum albumin scintigraphy and diagnostic laparoscopy showed that the tumor site was functional, while the surrounding area was a non-functional fibrotic area. A biopsy specimen indicated that the nodular lesion was an FNH-like lesion. She experienced several instances of variceal rupture and suffered liver failure, receiving liver transplantation. The excised liver showed a centrally scarred area in the nodule, indicating that the diagnosis was FNH. We herein report this case as a rare case of FNH that progressed to liver failure.

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References

  1. Libbrecht L, Cassiman D, Verslype C, et al. Clinicopathological features of focal nodular hyperplasia-like nodules in 130 cirrhotic explant livers. Am J Gastroenterol. 2006;101:2341–6.

    Article  Google Scholar 

  2. Bioulac-Sage P, Rebouissou S, Thomas C, et al. Hepatocellular adenoma subtype classification using molecular markers and immunohistochemistry. Hepatology. 2007;46:740–8.

    Article  CAS  Google Scholar 

  3. Margolskee E, Bao F, de Gonzalez AK, et al. Hepatocellular adenoma classification: a comparative evaluation of immunohistochemistry and targeted mutational analysis. Diagn Pathol. 2016;11:016–0475.

    Article  Google Scholar 

  4. Chuma M, Sakamoto M, Yamazaki K, et al. Expression profiling in multistage hepatocarcinogenesis: identification of HSP70 as a molecular marker of early hepatocellular carcinoma. Hepatology. 2003;37:198–207.

    Article  CAS  Google Scholar 

  5. Libbrecht L, Severi T, Cassiman D, et al. Glypican-3 expression distinguishes small hepatocellular carcinomas from cirrhosis, dysplastic nodules, and focal nodular hyperplasia-like nodules. Am J Surg Pathol. 2006;30:1405–11.

    Article  Google Scholar 

  6. Nguyen TB, Roncalli M, Di Tommaso L, et al. Combined use of heat-shock protein 70 and glutamine synthetase is useful in the distinction of typical hepatocellular adenoma from atypical hepatocellular neoplasms and well-differentiated hepatocellular carcinoma. Mod Pathol. 2016;29:283–92.

    Article  CAS  Google Scholar 

  7. Narita M, Hatano E, Arizono S, et al. Expression of OATP1B3 determines uptake of Gd-EOB-DTPA in hepatocellular carcinoma. J Gastroenterol. 2009;44:793–8.

    Article  CAS  Google Scholar 

  8. Scheuer PJ. Classification of chronic viral hepatitis: a need for reassessment. J Hepatol. 1991;13:372–4.

    Article  CAS  Google Scholar 

  9. Sherlock S, Feldman CA, Moran B, et al. Partial nodular transformation of the liver with portal hypertension. Am J Med. 1966;40:195–203.

    Article  CAS  Google Scholar 

  10. Guido M, Alves VAF, Balabaud C, et al. Histology of portal vascular changes associated with idiopathic non-cirrhotic portal hypertension: nomenclature and definition. Histopathology. 2019;74:219–26.

    Article  Google Scholar 

  11. Giannitrapani L, Soresi M, La Spada E, et al. Sex hormones and risk of liver tumor. Ann N Y Acad Sci. 2006;1089:228–36.

    Article  CAS  Google Scholar 

  12. Maillette de Buy Wenniger L, Terpstra V, Beuers U. Focal nodular hyperplasia and hepatic adenoma: epidemiology and pathology. Dig Surg. 2010;27:24–31.

  13. Nault JC, Paradis V, Cherqui D, et al. Molecular classification of hepatocellular adenoma in clinical practice. J Hepatol. 2017;67:1074–83.

    Article  CAS  Google Scholar 

  14. Takahashi S, Miyanishi K, Takada K, et al. Case report of a focal nodular hyperplasia-like nodule present in cirrhotic liver. Hepatol Res. 2008;38:521–8.

    Article  Google Scholar 

  15. Kondo F. Focal nodular hyperplasia-like lesions in heavy drinkers. Intern Med. 2009;48(13):1117–23 (Epub 2009 Jul 1.; 2009).

    Article  Google Scholar 

  16. Kondo F. Benign nodular hepatocellular lesions caused by abnormal hepatic circulation: etiological analysis and introduction of a new concept. J Gastroenterol Hepatol. 2001;16:1319–28.

    Article  CAS  Google Scholar 

  17. Okudaira S. Clinicopathologic study on 23 resected cases of focal nodular hyperplasia. Kanzo. 1993;34:621–9.

    Article  Google Scholar 

  18. Wanless IR, Albrecht S, Bilbao J, 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;2:456–62.

    CAS  PubMed  Google Scholar 

  19. Rebouissou S, Bioulac-Sage P, Zucman-Rossi J. Molecular pathogenesis of focal nodular hyperplasia and hepatocellular adenoma. J Hepatol. 2008;48:163–70.

    Article  CAS  Google Scholar 

  20. Kondo F, Koshima Y, Ebara M. Nodular lesions associated with abnormal liver circulation. Intervirology. 2004;47:277–87.

    Article  Google Scholar 

  21. Nakanuma Y, Hoso M, Sasaki M, et al. Histopathology of the liver in non-cirrhotic portal hypertension of unknown aetiology. Histopathology. 1996;28:195–204.

    Article  CAS  Google Scholar 

  22. De Gottardi A, Rautou PE, Schouten J, et al. Porto-sinusoidal vascular disease: proposal and description of a novel entity. Lancet Gastroenterol Hepatol. 2019;4:399–411.

    Article  Google Scholar 

  23. Kang JH, Kim DH, Kim SY, et al. Porto-sinusoidal vascular disease with portal hypertension versus liver cirrhosis: differences in imaging features on CT and hepatobiliary contrast-enhanced MRI. Abdom Radiol (NY). 2020. https://doi.org/10.1007/s00261-020-02831-w.

    Article  PubMed  Google Scholar 

  24. Glatard AS, Hillaire S, d’Assignies G, et al. Obliterative portal venopathy: findings at CT imaging. Radiology. 2012;263:741–50.

    Article  Google Scholar 

  25. Merli L, Grimaldi C, Monti L, et al. Liver transplantation for refractory severe pruritus related to widespread multifocal hepatic focal nodular hyperplasia (FNH) in a child: case report and review of literature. Pediatr Transplant. 2012;16:E265–8.

    Article  CAS  Google Scholar 

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Authors and Affiliations

Authors

Contributions

TY participated in the actual diagnosis and treatment of the case, data analysis, and writing of the paper; YT participated in the writing of the paper; AT participated in the actual diagnosis and treatment of the case, data analysis, and writing of the paper; FK and KK participated in the pathological diagnosis; TY participated in the liver transplantation and post-transplantation care for the case; AO, TA, NW, HO, and HS participated in the actual diagnosis and treatment of the case; HO participated in the actual writing of the paper

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Correspondence to Akinobu Takaki.

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Tetsuya Yasunaka, Yasuto Takeuchi, Akinobu Takaki, Fukuo Kondo, Tomoharu Yoshizumi, Kenichi Kohashi, Atsushi Oyama, Takuya Adachi, Nozomu Wada, Hideki Onishi, Hidenori Shiraha and Hiroyuki Okada declare that they have no conflict of interest.

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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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We could not earn informed consent from the patient because she cannot be traced now. This case report does not contain identifying information of the patient.

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Yasunaka, T., Takeuchi, Y., Takaki, A. et al. A case of focal nodular hyperplasia with hepatic failure treated with liver transplantation. Clin J Gastroenterol 15, 171–176 (2022). https://doi.org/10.1007/s12328-021-01529-w

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  • DOI: https://doi.org/10.1007/s12328-021-01529-w

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