Difference between revisions of "Focal nodular hyperplasia"

Jump to navigation Jump to search

Focal nodular hyperplasia (view source)

Revision as of 21:05, 11 July 2016

6,200 bytes added ,  21:05, 11 July 2016
→‎Images: added a case of FNH with stains
(redirect)
 
(→‎Images: added a case of FNH with stains)
 
(3 intermediate revisions by one other user not shown)
Line 1: Line 1:
#redirect [[Medical_liver_disease#Focal_nodular_hyperplasia]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Focal_nodular_hyperplasia_-_intermed_mag.jpg
| Width      =
| Caption    = Focal nodular hyperplasia. [[H&E stain]].
| Synonyms  =
| Micro      = thick walled blood vessels without bile ducts of same size, bile ductular proliferation at the edge of the fibrosis tissue
| Subtypes  =
| LMDDx      = [[hepatic adenoma]], [[cirrhosis]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      = well circumscribed with capsule, lighter than surrounding parenchyma - may be yellow, +/-stellate central scar with thick vessels
| Grossing  =
| Site      = [[liver]] - see ''[[medical liver disease]]''
| Assdx      =
| Syndromes  = [[hereditary hemorrhagic telangiectasia]]
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence =
| Bloodwork  =
| Rads      = usu. solitary lesion, arterial phase enhancement in triphasic imaging
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    =
| Tx        =
}}
'''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 medical 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)].
 
{|
[[File:1 FNH 1 680x512px.tif|Trichrome shows fibrous scar with vessels/bile ductules (40X)]]
[[File:2 FNH 1 680x512px.tif|PAS-D shows tortuous bile ductules at edge of scar with minimal inflammation (200X)]]
[[File:3 FNH 1 680x512px.tif|PAS-D shows proliferated blood vessels in center of scar with minimal inflammation (200X).]]
[[File:4 FNH 1 680x512px.tif|Reticulin shows regeneration [two nuclei thick cords between black lines] (400X)]]
|}
Focal nodular hyperplasia. Trichrome shows fibrous scar with vessels/bile ductules (UL 40X). PAS-D shows tortuous bile ductules at edge of scar with minimal inflammation (UR 200X).
PAS-D shows proliferated blood vessels in center of scar with minimal inflammation (LL 200X). Reticulin shows regeneration [two nuclei thick cords between black lines] (LR 400X).
 
==See also==
*[[Medical liver disease]].
 
==References==
{{Reflist|2}}
 
[[Category:Diagnosis]]
[[Category:Medical liver disease]]
Mitchell
Account-creators
179

edits

Retrieved from "https://librepathology.org/wiki/Special:MobileDiff/7762...45419"

Navigation menu