Clinical analysis of 31 patients with hepatic focal nodular hyperplasia_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HUANG Ming ,  GUO Xiong , ZHANG Qi , GONG Liansheng

Hepatobiliary & Enteric Surgery Research Center, Xiangya Hospital, Central South University, Changsha 410008, P.R.China;

Corresponding?author：

GUO Xiong, Email: 123869115@qq.com

Keywords：

hepatic focal nodular hyperplasia; treatment; diagnosis; laparoscope

DOI：

10.7507/1007-9424.201703100

Video：

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Objective To summarize clinical features, imaging findings, diagnosis, treatment, and prognosis of patients with hepatic focal nodular hyperplasia. Method The clinical data of patients with hepatic focal nodular hyperplasia who underwent hepatectomy from July 2014 to July 2016 in the Xiangya Hospital of Central South University were analyzed retrospectively. Results There were 12 males and 19 females in the 31 patients with hepatic focal nodular hyperplasia, the male-to-female ratio was 1∶1.58. The age was from 15 to 67 years old with (39.7±11.5) years old. Physical examination found 21 cases, there were symptoms in 10 cases. Laboratory examination: only 2 patients with long-term drinking history had mild AST abnormality, HBsAgs of 6 cases were positive, CA19-9 level of one patient was slightly increased (40.54 kU/L). Thirteen patients with hepatic focal nodular hyperplasia were diagnosed by imaging examination, the diagnostic rate of MRI was significantly higher than that of color Doppler ultrasound (P<0.05) or CT (P<0.05). The diameter of the lesions ranged from 2 cm to 11 cm with (4.6±2.1) cm. All lesions were resected, including 13 cases by laparoscopic hepatectomy, and 18 cases by laparotomy. Compared with by the laparotomy, the intraoperative blood loss was less (P<0.05), the hospital stay and intestinal exhaust time were shorter (P<0.05) by the laparoscopic hepatectomy. Twenty-nine patients were followed up from 3 to 24 months, no patient died, the quality of life was better, no recurrence and metastasis happened. Conclusions Hepatic focal nodular hyperplasia is benign lesion, it has a good prognosis, generally without clinical symptoms, its laboratory feature has no abnormality. The combination of multiple imagings and pathological diagnosis could improve diagnosis rate. Surgical resection should be performed for suspected malignant tumor or other hepatic occupying lesions. Laparoscopic surgery has some advantages of quick recovery and less bleeding for it.

Citation： HUANG Ming, GUO Xiong, ZHANG Qi, GONG Liansheng. Clinical analysis of 31 patients with hepatic focal nodular hyperplasia. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(5): 541-545. doi: 10.7507/1007-9424.201703100 Copy

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2.	Nat L, Poant? LI. Focal nodular hyperplasia (FNH). Rom J Intern Med, 2014, 52(1): 45-49.
3.	Di Carlo I, Urrico GS, Ursino V, et al. Simultaneous occurrence of adenoma, focal nodular hyperplasia, and hemangioma of the liver: are they derived from a common origin? J Gastroenterol Hepatol, 2003, 18(2): 227-230.
4.	Edmondson HA. Tumors of the liver and intrahepatic bile ducts: Atlas of tumors pathology. Section 7. Fascicule 25. Washington DC: Armed Forces Institute of Pathology, 1958: 120.
5.	Ohmoto K, Honda T, Hirokawa M, et al. Spontaneous regression of focal nodular hyperplasia of the liver. J Gastroenterol, 2002, 37(10): 849-853.
6.	Mergo PJ, Ros PR. Benign lesions of the liver. Radiol Clin North Am, 1998, 36(2): 319-331.
7.	Mathieu D, Kobeiter H, Maison P, et al. Oral contraceptive use and focal nodular hyperplasia of the liver. Gastroenterology, 2000, 118(3): 560-564.
8.	Kapp N, Curtis KM. Hormonal contraceptive use among women with liver tumors: a systematic review. Contraception, 2009, 80(4): 387-390.
9.	Romano A, Grassia M, Esposito G, et al. An unusual case of left hepatectomy for focal nodular hyperplasia (FNH) linked to the use of anabolic androgenic steroids (AASs). Int J Surg Case Rep, 2017, 30: 169-171.
10.	Vilgrain V. Focal nodular hyperplasia. Eur J Radiol, 2006, 58(2): 236-245.
11.	王征旭, 胡桂芳, 吳孟超. 肝臟局灶性結節增生的診斷和治療(附 21 例報告). 中國普外基礎與臨床雜志, 2003, 10(2): 147-150.
12.	徐愛民, 程紅巖, 陳棟, 等. 肝臟局灶性結節增生的螺旋 CT 平掃及三期增強掃描. 中華腫瘤雜志, 2001, 23(5): 409-412.
13.	van den Esschert JW, van Gulik TM, Phoa SS. Imaging modalities for focal nodular hyperplasia and hepatocellular adenoma. Dig Surg, 2010, 27(1): 46-55.
14.	喬英艷, 王興華, 馬霞, 等. 肝臟局灶性病變超聲造影與增強 CT 動脈期增強特征的對比研究. 中國超聲醫學雜志, 2013, 29(1): 48-50.
15.	Brunel T, Guibal A, Boularan C, et al. Focal nodular hyperplasia and hepatocellular adenoma: The value of shear wave elastography for differential diagnosis. Eur J Radiol, 2015, 84(11): 2059-2064.
16.	閆春偉, 李艷靜. 肝臟局灶結節性增生的臨床與病理學表現分析. 實用肝臟病雜志, 2014, 17(5): 537-538.
17.	Hussain SM, Terkivatan T, Zondervan PE, et al. Focal nodular hyperplasia: findings at state-of-the-art MR imaging, US, CT, and pathologic analysis. Radiographics, 2004, 24(1): 3-19.
18.	李增榮, 陳本寶. 肝臟局灶性結節增生的 MSCT 診斷. 醫學影像學雜志, 2014, 24(6): 973-976.
19.	陳九如. 肝臟疾病影像學診斷與鑒別診斷(Ⅲ)肝臟病變的影像學診斷與鑒別診斷(下). 國際醫學放射學雜志, 2010, 33(4): 356-368.
20.	戴志軍, 馬軍, 吳小紅, 等. 釓塞酸二鈉增強 MRI 在肝臟結節性病變中的診斷價值. 寧夏醫學雜志, 2015, 37(1): 55-57.
21.	Palmucci S. Focal liver lesions detection and characterization: The advantages of gadoxetic acid-enhanced liver MRI. World J Hepatol, 2014, 6(7): 477-485.
22.	McInnes MD, Hibbert RM, Inácio JR, et al. Focal nodular hyperplasia and hepatocellular adenoma: accuracy of gadoxetic acid-enhanced MR imaging–A systematic review. Radiology, 2015, 277(2): 413-423.
23.	Ramírez-Fuentes C, Martí-Bonmatí L, Torregrosa A,et al. Variations in the size of focal nodular hyperplasia on magnetic resonance imaging. Radiologia, 2013, 55(6): 499-504.
24.	孫健, 王捷. 肝臟局灶性結節性增生診斷及規范化治療. 中國實用外科雜志, 2013, 33(9): 742-745.

1. ?Maillette de Buy Wenniger L, Terpstra V, Beuers U. Focal nodular hyperplasia and hepatic adenoma: epidemiology and pathology. Dig Surg, 2010, 27(1): 24-31.
2. Nat L, Poant? LI. Focal nodular hyperplasia (FNH). Rom J Intern Med, 2014, 52(1): 45-49.
3. Di Carlo I, Urrico GS, Ursino V, et al. Simultaneous occurrence of adenoma, focal nodular hyperplasia, and hemangioma of the liver: are they derived from a common origin? J Gastroenterol Hepatol, 2003, 18(2): 227-230.
4. Edmondson HA. Tumors of the liver and intrahepatic bile ducts: Atlas of tumors pathology. Section 7. Fascicule 25. Washington DC: Armed Forces Institute of Pathology, 1958: 120.
5. Ohmoto K, Honda T, Hirokawa M, et al. Spontaneous regression of focal nodular hyperplasia of the liver. J Gastroenterol, 2002, 37(10): 849-853.
6. Mergo PJ, Ros PR. Benign lesions of the liver. Radiol Clin North Am, 1998, 36(2): 319-331.
7. Mathieu D, Kobeiter H, Maison P, et al. Oral contraceptive use and focal nodular hyperplasia of the liver. Gastroenterology, 2000, 118(3): 560-564.
8. Kapp N, Curtis KM. Hormonal contraceptive use among women with liver tumors: a systematic review. Contraception, 2009, 80(4): 387-390.
9. Romano A, Grassia M, Esposito G, et al. An unusual case of left hepatectomy for focal nodular hyperplasia (FNH) linked to the use of anabolic androgenic steroids (AASs). Int J Surg Case Rep, 2017, 30: 169-171.
10. Vilgrain V. Focal nodular hyperplasia. Eur J Radiol, 2006, 58(2): 236-245.
11. 王征旭, 胡桂芳, 吳孟超. 肝臟局灶性結節增生的診斷和治療(附 21 例報告). 中國普外基礎與臨床雜志, 2003, 10(2): 147-150.
12. 徐愛民, 程紅巖, 陳棟, 等. 肝臟局灶性結節增生的螺旋 CT 平掃及三期增強掃描. 中華腫瘤雜志, 2001, 23(5): 409-412.
13. van den Esschert JW, van Gulik TM, Phoa SS. Imaging modalities for focal nodular hyperplasia and hepatocellular adenoma. Dig Surg, 2010, 27(1): 46-55.
14. 喬英艷, 王興華, 馬霞, 等. 肝臟局灶性病變超聲造影與增強 CT 動脈期增強特征的對比研究. 中國超聲醫學雜志, 2013, 29(1): 48-50.
15. Brunel T, Guibal A, Boularan C, et al. Focal nodular hyperplasia and hepatocellular adenoma: The value of shear wave elastography for differential diagnosis. Eur J Radiol, 2015, 84(11): 2059-2064.
16. 閆春偉, 李艷靜. 肝臟局灶結節性增生的臨床與病理學表現分析. 實用肝臟病雜志, 2014, 17(5): 537-538.
17. Hussain SM, Terkivatan T, Zondervan PE, et al. Focal nodular hyperplasia: findings at state-of-the-art MR imaging, US, CT, and pathologic analysis. Radiographics, 2004, 24(1): 3-19.
18. 李增榮, 陳本寶. 肝臟局灶性結節增生的 MSCT 診斷. 醫學影像學雜志, 2014, 24(6): 973-976.
19. 陳九如. 肝臟疾病影像學診斷與鑒別診斷(Ⅲ)肝臟病變的影像學診斷與鑒別診斷(下). 國際醫學放射學雜志, 2010, 33(4): 356-368.
20. 戴志軍, 馬軍, 吳小紅, 等. 釓塞酸二鈉增強 MRI 在肝臟結節性病變中的診斷價值. 寧夏醫學雜志, 2015, 37(1): 55-57.
21. Palmucci S. Focal liver lesions detection and characterization: The advantages of gadoxetic acid-enhanced liver MRI. World J Hepatol, 2014, 6(7): 477-485.
22. McInnes MD, Hibbert RM, Inácio JR, et al. Focal nodular hyperplasia and hepatocellular adenoma: accuracy of gadoxetic acid-enhanced MR imaging–A systematic review. Radiology, 2015, 277(2): 413-423.
23. Ramírez-Fuentes C, Martí-Bonmatí L, Torregrosa A,et al. Variations in the size of focal nodular hyperplasia on magnetic resonance imaging. Radiologia, 2013, 55(6): 499-504.
24. 孫健, 王捷. 肝臟局灶性結節性增生診斷及規范化治療. 中國實用外科雜志, 2013, 33(9): 742-745.

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Clinical analysis of 31 patients with hepatic focal nodular hyperplasia

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