Journal List > Korean J Gastroenterol > v.64(1) > 1007322

TOOLS
Chung, Park, Kim, Han, Lee, Choi, Bae, and Park: Recurrence of Multiple Focal Nodular Hyperplasia in a Young Male Patient
Case Report

Korean J Gastroenterol 2014;64(1):49-53.

Published online: 4 October 2014

DOI: https://doi.org/10.4166/kjg.2014.64.1.49

Recurrence of Multiple Focal Nodular Hyperplasia in a Young Male Patient

Eun Chung, Chung-Hwa Park, Jeana Kim, Nam Ik Han, Young Sok Lee, Ho Joong Choi, Si Hyun Bae, Il Young Park

Departments of Internal Medicine, Hospital Pathology, and General Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to: Il Young Park, Department of General Surgery, The Catholic University of Korea, Bucheon St. Mary's Hospital, 327 Sosa-ro, Wonmi-gu, Bucheon 420-717, Korea. Tel: +82-32-340-7021, Fax: +82-32-340-7227, E-mail: parkiy@catholic.ac.kr

Received 7 October 20136 January 2014       Accepted 8 January 2014

Copyright © 2014 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Focal nodular hyperplasia (FNH) is the second most common benign hepatic tumor that is usually found in women. Diagnosis of FNH mainly depends on imaging studies such as color Doppler flow imaging, computed tomography, and magnetic resonance imaging. It is characterized by the presence of stellate central scar and is nowadays incidentally diagnosed with increasing frequency due to advances in radiologic imaging technique. FNH typically presents as a single lesion in 70% of cases and generally does not progress to malignancy or recur after resection. Herein, we report a case of a young male patient with recurrent multiple FNH who underwent surgical resection for presumed hepatic adenoma on computed tomography.

Keywords: Focal nodular hyperplasia, Diagnosis

References

1. Cristiano A, Dietrich A, Spina JC, Ardiles V, de Santibañes E. Focal nodular hyperplasia and hepatic adenoma: current diagnosis and management. Updates Surg. 2014; 66:9–21.
crossref
2. Carlson SK, Johnson CD, Bender CE, Welch TJ. CT of focal nodular hyperplasia of the liver. AJR Am J Roentgenol. 2000; 174:705–712.
crossref
3. Wanless IR, Mawdsley C, Adams R. On the pathogenesis of focal nodular hyperplasia of the liver. Hepatology. 1985; 5:1194–1200.
crossref
4. Shen YH, Fan J, Wu ZQ, et al. Focal nodular hyperplasia of the liver in 86 patients. Hepatobiliary Pancreat Dis Int. 2007; 6:52–57.
5. Sudour H, Mainard L, Baumann C, Clement L, Salmon A, Bordigoni P. Focal nodular hyperplasia of the liver following hematopoietic SCT. Bone Marrow Transplant. 2009; 43:127–132.
crossref
6. Kim J, Nikiforov YE, Moulton JS, Lowy AM. Multiple focal nodular hyperplasia of the liver in a 21-year-old woman. J Gastrointest Surg. 2004; 8:591–595.
crossref
7. Fabre A, Audet P, Vilgrain V, et al. Histologic scoring of liver biopsy in focal nodular hyperplasia with atypical presentation. Hepatology. 2002; 35:414–420.
crossref
8. Procacci C, Fugazzola C, Cinquino M, et al. Contribution of CT to characterization of focal nodular hyperplasia of the liver. Gastrointest Radiol. 1992; 17:63–73.
crossref
9. Finley AC, Hosey JR, Noone TC, Shackelford DM, Varadarajulu S. Multiple focal nodular hyperplasia syndrome: diagnosis with dynamic, gadolinium-enhanced MRI. Magn Reson Imaging. 2005; 23:511–513.
crossref
10. Bieze M, Bennink RJ, El-Massoudi Y, et al. The use of 18F-fluo-romethylcholine PET/CT in differentiating focal nodular hyperplasia from hepatocellular adenoma: a prospective study of diagnostic accuracy. Nucl Med Commun. 2013; 34:146–154.
11. Sadowski DC, Lee SS, Wanless IR, Kelly JK, Heathcote EJ. Progressive type of focal nodular hyperplasia characterized by multiple tumors and recurrence. Hepatology. 1995; 21:970–975.
crossref
12. Shetty JB, Amrapurkar AD, Shenoy AS. Multiple focal nodular hyperplasia, an incidental finding on autopsy. Indian J Pathol Microbiol. 2011; 54:822–824.
13. 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; 2:456–462.
14. Devarbhavi H, Abraham S, Kamath PS. Significance of nodular regenerative hyperplasia occurring de novo following liver transplantation. Liver Transpl. 2007; 13:1552–1556.
crossref
15. Donadon M, Di Tommaso L, Roncalli M, Torzilli G. Multiple focal nodular hyperplasias induced by oxaliplatin-based chemotherapy. World J Hepatol. 2013; 5:340–344.
crossref

Fig. 1.
Three phase CT images showing ovoid heterogeneous masses that predominantly appear as hypoattenuating lesions on portal venous phase. (A, B) Prior to the first operation, the mass (white arrows) is located in the left lateral segment. (C, D) After 3 years, a new lesion is seen in segment 6 (asterisks).
kjg-64-49f1.tif
Fig. 2.
(A) Microscopic findings of the specimen from the first operation shows a non-encapsulated, well defined hepatocellular nodule (H&E,×40). (B) Within the nodule, arteries with thick wall (white arrow) and reactive bile ducts (white arrowhead) are seen (H&E, ×100). (C) The other specimen achieved after the second operation shows radiating fibrous septa (asterisks) dividing the tumor into nodules (H&E, ×40). (D) The hepatocytes in the nodular lesion without definite capsule shows no pleomorphism or cytologic atypia (black arrow) compared to normal parenchyma at the right (black arrowhead) (H&E, ×100).
kjg-64-49f2.tif
Fig. 3.
MRI taken during follow-up. (A, B) The lesion (white arrows) shows iso- and subtle high signal intensity compared to the adjacent liver parenchyma on arterial phase and low signal intensity on portal phase. (C, D) Small hypodense lesions (asterisks) with similar characteristics are seen in segment 4 on portal venous phase.
kjg-64-49f3.tif
TOOLS
Similar articles