Focal nodular hyperplasia of the liver

Abstract

Background: Focal nodular hyperplasia (FNH), an expansive neoplasm of the liver, was regarded as a rare condition in the past but is nowadays more frequently identified. This can be attributed to the widespread use of uninvasive screening and diagnosing techniques, like imaging by ultrasonography. In our study, all patients with FNH were retrospectively analyzed with regard to diagnostic and therapeutic techniques, and the influence of surgical and conservative therapies was presented. Methods: We diagnosed 41 FNH in 39 patients over a period of 20 years. All patient histories, laboratory, radiological, and anatomo-pathological data were evaluated. Results: Clinical symptoms attributable to FNH were found in 16 out of 39 patients (41%). 11 of 30 women were under oral contraceptives (OC). The hormone status of all patients was within the normal range. An increase in gamma-glutamyl transpeptidase in 15 out of 32 patients (46.8%) was the only biochemical clue to FNH; alpha-fetoprotein and carcinoembryonic antigen values were normal. It is possible to obtain a reliable preoperative diagnosis by combining different imaging techniques, such as computerized axial tomography, Tc-99m-colloid scintigraphy and Tc-99m-diisopropyl iminodiacetic acid scintigraphy. Cytologic examinations by ultrasonic fine needle aspiration of the liver proved to be helpful. 32 FNH were excised in 31 patients, in 4 patients biopsy was performed. Postoperative mortality was 0. In 5 FNH in 4 patients malignant changes were cytologically excluded after radiological results had pointed to FNH; the radiologic and biochemical follow-up examinations of these patients every 6 months did not reveal any increase in FNH size. Conclusions: Only patients with symptomatic forms of FNH or those risking a rupture or torsion should be surgically treated. In asymptomatic patients, short-term follow-ups are an adequate method of monitoring. In case the lesion grows, a total removal is indicated.