Difference between revisions of "Medical liver disease"

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→‎Focal nodular hyperplasia: split
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==Focal nodular hyperplasia==
==Focal nodular hyperplasia==
*Abbreviated ''FNH''.
*Abbreviated ''FNH''.
===General===
{{Main|Focal nodular hyperplasia}}
*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)].


==Nodular regenerative hyperplasia==
==Nodular regenerative hyperplasia==
Michael
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