Difference between revisions of "Focal nodular hyperplasia"
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# | '''Focal nodular hyperplasia''', abbreviated '''FNH''', is a benign [[liver]] lesion, uncommonly seen by pathologists. | ||
==General== | |||
*Not commonly seen by pathologists, as these are usually distinctive on medical imaging.<ref name=pmid11274535>{{Cite journal | last1 = Brancatelli | first1 = G. | last2 = Federle | first2 = MP. | last3 = Grazioli | first3 = L. | last4 = Blachar | first4 = A. | last5 = Peterson | first5 = MS. | last6 = Thaete | first6 = L. | title = Focal nodular hyperplasia: CT findings with emphasis on multiphasic helical CT in 78 patients. | journal = Radiology | volume = 219 | issue = 1 | pages = 61-8 | month = Apr | year = 2001 | doi = | PMID = 11274535 }}</ref> | |||
*Benign lesions. | |||
*May be seen in the context of [[hereditary hemorrhagic telangiectasia]].<ref name=pmid18814078>{{cite journal |author=Khalid SK, Garcia-Tsao G |title=Hepatic vascular malformations in hereditary hemorrhagic telangiectasia |journal=Semin. Liver Dis. |volume=28 |issue=3 |pages=247–58 |year=2008 |month=August |pmid=18814078 |doi=10.1055/s-0028-1085093 |url=}}</ref> | |||
Note: | |||
*Oral contraceptive pill (OCP) use does '''not''' appear to be a factor in the growth of these lesions;<ref name=pmid19751862>{{Cite journal | last1 = Kapp | first1 = N. | last2 = Curtis | first2 = KM. | title = Hormonal contraceptive use among women with liver tumors: a systematic review. | journal = Contraception | volume = 80 | issue = 4 | pages = 387-90 | month = Oct | year = 2009 | doi = 10.1016/j.contraception.2009.01.021 | PMID = 19751862 }}</ref> however, the study claims there is nothing on [[hepatocellular adenoma]]s -- yet I found a ''JAMA'' paper by Rooks ''et al.''<ref name=pmid221698>{{Cite journal | last1 = Rooks | first1 = JB. | last2 = Ory | first2 = HW. | last3 = Ishak | first3 = KG. | last4 = Strauss | first4 = LT. | last5 = Greenspan | first5 = JR. | last6 = Hill | first6 = AP. | last7 = Tyler | first7 = CW. | title = Epidemiology of hepatocellular adenoma. The role of oral contraceptive use. | journal = JAMA | volume = 242 | issue = 7 | pages = 644-8 | month = Aug | year = 1979 | doi = | PMID = 221698 }}</ref> on this topic. | |||
===Imaging=== | |||
*FNH enhances on the arterial phase in triphasic imaging, i.e. triphasic CT or MRI.<ref name=emedicine_fnh>[http://emedicine.medscape.com/article/368377-overview http://emedicine.medscape.com/article/368377-overview]</ref><ref name=pmid11274535>{{Cite journal | last1 = Brancatelli | first1 = G. | last2 = Federle | first2 = MP. | last3 = Grazioli | first3 = L. | last4 = Blachar | first4 = A. | last5 = Peterson | first5 = MS. | last6 = Thaete | first6 = L. | title = Focal nodular hyperplasia: CT findings with emphasis on multiphasic helical CT in 78 patients. | journal = Radiology | volume = 219 | issue = 1 | pages = 61-8 | month = Apr | year = 2001 | doi = | PMID = 11274535 }}</ref> | |||
==Gross== | |||
Features:<ref name=Ref_PBoD922>{{Ref PBoD|922}}</ref> | |||
*Well circumscribed, but no capsule. | |||
*Lighter than surrounding parenchyma, may be yellow. | |||
*+/-Stellate central scar with thick vessels. | |||
**Can be identified on medial imaging. | |||
Note: Usually a solitary lesion.<ref name=emedicine_fnh/> | |||
==Microscopic== | |||
Features:<ref name=Ref_PBoD922>{{Ref PBoD|922}}</ref> | |||
*Classically a stellate scar that has large arteries with fibromuscular hyperplasia. | |||
**Thin fibrous septa radiate from the central scar - surrounded by lymphocytes & bile ductules. | |||
***Normal hepatocytes between fibrous septae. | |||
Practical features: | |||
#Thick walled blood vessels. | |||
#*Bile duct of same size not seen. | |||
#Bile ductular proliferation at the edge of the fibrosis tissue. | |||
#Clinical history: it is a focal lesion. | |||
DDx: | |||
*[[Hepatic adenoma]] - may be difficult to distinguish, if no scar and no ductal proliferation.<ref>STC. 19 Jan 2009.</ref> | |||
*[[Cirrhosis]] - complete nodules | |||
**FNH has incomplete nodules. | |||
Memory device ''FNH'' = '''f'''ocal lesion, '''n'''umerous bile ductules, '''h'''yperplasia of arteries. | |||
===Images=== | |||
<gallery> | |||
Image:Focal_nodular_hyperplasia_-_low_mag.jpg | FNH - looks a bit like cirrhosis - low mag. (WC) | |||
Image:Focal_nodular_hyperplasia_-_intermed_mag.jpg | FNH - intermed. mag. (WC) | |||
Image:Focal_nodular_hyperplasia_-_high_mag.jpg | FNH - high mag. (WC) | |||
</gallery> | |||
www: | |||
*[http://path.upmc.edu/cases/case444.html FNH - several images (upmc.edu)]. | |||
==See also== | |||
*[[Medical liver disease]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Medical liver disease]] | |||
Revision as of 04:38, 17 September 2014
Focal nodular hyperplasia, abbreviated FNH, is a benign liver lesion, uncommonly seen by pathologists.
General
- Not commonly seen by pathologists, as these are usually distinctive on medical imaging.[1]
- Benign lesions.
- May be seen in the context of hereditary hemorrhagic telangiectasia.[2]
Note:
- Oral contraceptive pill (OCP) use does not appear to be a factor in the growth of these lesions;[3] however, the study claims there is nothing on hepatocellular adenomas -- yet I found a JAMA paper by Rooks et al.[4] on this topic.
Imaging
Gross
Features:[6]
- Well circumscribed, but no capsule.
- Lighter than surrounding parenchyma, may be yellow.
- +/-Stellate central scar with thick vessels.
- Can be identified on medial imaging.
Note: Usually a solitary lesion.[5]
Microscopic
Features:[6]
- Classically a stellate scar that has large arteries with fibromuscular hyperplasia.
- Thin fibrous septa radiate from the central scar - surrounded by lymphocytes & bile ductules.
- Normal hepatocytes between fibrous septae.
- Thin fibrous septa radiate from the central scar - surrounded by lymphocytes & bile ductules.
Practical features:
- Thick walled blood vessels.
- Bile duct of same size not seen.
- Bile ductular proliferation at the edge of the fibrosis tissue.
- Clinical history: it is a focal lesion.
DDx:
- Hepatic adenoma - may be difficult to distinguish, if no scar and no ductal proliferation.[7]
- Cirrhosis - complete nodules
- FNH has incomplete nodules.
Memory device FNH = focal lesion, numerous bile ductules, hyperplasia of arteries.
Images
FNH - looks a bit like cirrhosis - low mag. (WC)
FNH - intermed. mag. (WC)
FNH - high mag. (WC)
www:
See also
References
- ↑ 1.0 1.1 Brancatelli, G.; Federle, MP.; Grazioli, L.; Blachar, A.; Peterson, MS.; Thaete, L. (Apr 2001). "Focal nodular hyperplasia: CT findings with emphasis on multiphasic helical CT in 78 patients.". Radiology 219 (1): 61-8. PMID 11274535.
- ↑ Khalid SK, Garcia-Tsao G (August 2008). "Hepatic vascular malformations in hereditary hemorrhagic telangiectasia". Semin. Liver Dis. 28 (3): 247–58. doi:10.1055/s-0028-1085093. PMID 18814078.
- ↑ Kapp, N.; Curtis, KM. (Oct 2009). "Hormonal contraceptive use among women with liver tumors: a systematic review.". Contraception 80 (4): 387-90. doi:10.1016/j.contraception.2009.01.021. PMID 19751862.
- ↑ Rooks, JB.; Ory, HW.; Ishak, KG.; Strauss, LT.; Greenspan, JR.; Hill, AP.; Tyler, CW. (Aug 1979). "Epidemiology of hepatocellular adenoma. The role of oral contraceptive use.". JAMA 242 (7): 644-8. PMID 221698.
- ↑ 5.0 5.1 http://emedicine.medscape.com/article/368377-overview
- ↑ 6.0 6.1 Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 922. ISBN 0-7216-0187-1.
- ↑ STC. 19 Jan 2009.