Detection of focal nodular hyperplasia with liver colloid single photon emission computed tomography: a case report and review of the literature

Abstract

Focal nodular hyperplasia (FNH) is a benign hamartomatous liver mass (Robbins et al, 1984). It is usually identified incidentally during ultrasonographic examination, other diagnostic procedures or autopsy. The patients are often asymptomatic (Drum, 1982). Physical examination is found to be normal in most of the cases. Jaundice, hepatomegaly, palpable mass, and chronic intermittent vague abdominal pain, especially in the right upper quadrant, may be present in some patients. Eighty-eight per cent of the cases are female, of whom 80% give a history of oral contraceptive or supplemental oestrogen use (Kerlin et al, 1983). The lesion may be solitary (55%) or multiple, and it is usually located in the right lobe of the liver (Rogers et al, 1981), varying in size between 1 and 20 cm, and containing hepatocytes, bile ducts and Kuppfer cells (Rogers et al, 1981; Robbins et al, 1984). Colloid scintigraphic appearance may be hyperactive (40%), hypoactive (30–60%) or normoactive (30–55%) (Diament et al, 1982; Kerlin et al, 1983; Rogers et al, 1981; Welch et al, 1985). A central, stellate-shaped collageneous scar with peripherally radiating septa is the typical histopathologic feature of FNH (Kerlin et al, 1983; Rogers et al, 1981). We present a case of FNH with planar colloid scintigraphy demonstrating slightly increased uptake in the ultrasonographically detected lesion. Single photon emission computed tomography (SPECT) showed a hyperactive region at the lesion site.