|
|
| Line 1: |
Line 1: |
| {{Infobox_Disease |
| | __NOTOC__ |
| Name = {{PAGENAME}} |
| | {{Focal nodular hyperplasia}} |
| Image = FNH-005.jpg|
| |
| Caption = Focal nodular hyperplasia. <br> [http://www.radswiki.net Image courtesy of RadsWiki]|
| |
| DiseasesDB = 33467 |
| |
| ICD10 = |
| |
| ICD9 = |
| |
| ICDO = |
| |
| OMIM = |
| |
| MedlinePlus = |
| |
| eMedicineSubj = radio |
| |
| eMedicineTopic = 286 |
| |
| MeshID = D020518 |
| |
| }}
| |
| {{SI}}
| |
| {{CMG}}
| |
|
| |
|
| '''Contributors:''' [[User:zorkun|Cafer Zorkun]] M.D., PhD.
| | {{CMG}}; {{AE}} {{Your Name}} |
|
| |
|
| | ==[[Focal nodular hyperplasia overview|Overview]]== |
|
| |
|
| | ==[[Focal nodular hyperplasia historical perspective|Historical Perspective]]== |
|
| |
|
| ==Overview== | | ==[[Focal nodular hyperplasia classification|Classification]]== |
|
| |
|
| '''Focal nodular hyperplasia''' (FNH) is a benign [[tumor]] of the [[liver]] ([[hepatic tumor]]), which is the second most prevalent tumor of the liver (the first is hepatic hemangioma). It is usually asymptomatic, rarely grows or bleeds, and has no malignant potential. This tumor is often resected because it is difficult to distinguish from [[adenoma#Liver|hepatic adenoma]]. <ref>Shahid M. Hussain, Türkan Terkivatan, Pieter E. Zondervan, Esmée Lanjouw, Sjoerd de Rave, Jan N. M. IJzermans, and Rob A. de Man. [http://radiographics.rsnajnls.org/cgi/content/abstract/24/1/3 Focal Nodular Hyperplasia: Findings at State-of-the-Art MR Imaging, US, CT, and Pathologic Analysis.] RadioGraphics 2004 24: 3-17.</ref>
| | ==[[Focal nodular hyperplasiae pathophysiology|Pathophysiology]]== |
|
| |
|
| * Focal nodular hyperplasia is believed to occur as a result of a localized hepatocyte response to an underlying congenital arteriovenous malformation.
| | ==[[Focal nodular hyperplasia causes|Causes]]== |
| * Focal nodular hyperplasia is a hyperplastic process in which all the normal constituents of the liver are present but in an abnormally organized pattern.
| |
| * Malignant transformation of Focal nodular hyperplasia has not been reported.
| |
| * Focal nodular hyperplasia must be differentiated from fibrolamellar carcinoma, with which it shares imaging and gross features.
| |
| * Male-to-female ratio is 1:2-4.
| |
|
| |
|
| ==Clinical Presentation== | | ==[[Focal nodular hyperplasia differential diagnosis|Differentiating Focal nodular hyperplasia from other Diseases]]== |
|
| |
|
| Focal nodular hyperplasia's most recognizable gross feature is a central stellate scar seen in 60-70% of cases. Microscopically, a lobular proliferation of bland-appearing hepatocytes with a bile ductular proliferation and malformed vessels within the fibrous scar is the most common pattern. Other patterns include telangiectatic, hyperplastic-adenomatous, and lesions with focal large-cell dysplasia.<ref name=Nguyen>Nguyen et al. Focal Nodular Hyperplasia of the Liver: A Comprehensive Pathologic Study of 305 Lesions and Recognition of New Histologic Forms. Am J Surg Path 1999: 23 (12); 1441-4.</ref> Rarely, these lesions may be multiple or can occur as part of a syndrome with hemangiomas, epithelioid hemangioendothelioma, hepatic adenomas, fibrolamellar hepatocellular carcinoma, vascular malformations of the brain, meningiomas, and/or astrocytomas.<ref name=Nguyen/> | | ==[[Focal nodular hyperplasia epidemiology and demographics|Epidemiology and Demographics]]== |
|
| |
|
| ==Diagnosis== | | ==[[Focal nodular hyperplasiarisk factors|Risk Factors]]== |
|
| |
|
| ===Computed Tomography=== | | ==[[Focal nodular hyperplasia screening|Screening]]== |
|
| |
|
| * Lobulated contours at CT.
| | ==[[Focal nodular hyperplasia natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| * At unenhanced CT, the lesions are either hypoattenuating or isoattenuating to the surrounding [[liver]].
| |
| * In the arterial phase, the lesions become hyperattenuating due to the homogeneous intense enhancement of the entire lesion, except the central scar.
| |
| * In the portal and later phases, the lesions become more isoattenuating with the surrounding liver and the central scar may show some enhancement.
| |
| | |
| ===MRI===
| |
| | |
| * Often isointense on T1-weighted images.
| |
| * Often isointense on T2-weighted images.
| |
| * Central scar
| |
| ** Hypointense on T1-weighted images
| |
| ** Variable signal-intensity pattern on T2-weighted images.
| |
| * Contrast
| |
| ** Dense enhancement is seen in the arterial phase,
| |
| ** Isointense during the portal venous phase
| |
| ** Isointense on delayed images.
| |
| ** Late and prolonged enhancement of the central stellate scar occasionally occurs.
| |
| | |
| ===Scintigraphy===
| |
| | |
| * Will display uptake on sulfur colloid scan as Focal nodular hyperplasias contain Kupffer cells.
| |
| * Other hepatic lesions will be cold defects on sulfur colloid scans.
| |
| | |
| ==Diagnostic Findings==
| |
| | |
| [http://www.radswiki.net Images courtesy of RadsWiki]
| |
| | |
| <gallery perRow="3">
| |
| Image:FNH-001.jpg|Axial T1 pre
| |
| Image:FNH-002.jpg|Axial T1 post
| |
| Image:FNH-003.jpg|Axial T1 post delayed
| |
| Image:FNH-004.jpg|Axial T2
| |
| Image:FNH-005.jpg|Coronal T2
| |
| </gallery>
| |
| | |
| ==References==
| |
| {{Reflist|2}}
| |
| | |
| ==External Links==
| |
| | |
| * [http://www.emedicine.com/radio/topic286.htm E-medicine radiology article]
| |
|
| |
|
| | ==Diagnosis== |
| | [[Focal nodular hyperplasia history and symptoms|History and Symptoms]] | [[Focal nodular hyperplasia physical examination|Physical Examination]] | [[Focal nodular hyperplasia laboratory findings|Laboratory Findings]] | [[Focal nodular hyperplasia electrocardiogram|Electrocardiogram]] |[[Focal nodular hyperplasia x ray|X Ray]] | [[Focal nodular hyperplasia CT|CT]] | [[Focal nodular hyperplasia MRI|MRI]] | | [[Focal nodular hyperplasia other imaging findings|Other Imaging Findings]] | [[Focal nodular hyperplasia other diagnostic studies|Other Diagnostic Studies]] |
|
| |
|
| {{Digestive system neoplasia}}
| | ==Treatment== |
| | [[Focal nodular hyperplasia medical therapy|Medical Therapy]] | [[Focal nodular hyperplasia surgery|Surgery]] | [[Focal nodular hyperplasia primary prevention|Primary Prevention]] | [[Focal nodular hyperplasia secondary prevention|Secondary Prevention]] | [[Focal nodular hyperplasia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Focal nodular hyperplasia future or investigational therapies|Future or Investigational Therapies]] |
|
| |
|
| | ==Case Studies== |
| | [[Focal nodular hyperplasia case study one|Case #1]] |
|
| |
|
|
| |
|
| [[Category:Hepatology]] | | [[Category:Hepatology]] |
|
| |
|
| {{WikiDoc Help Menu}} | | {{WH}} |
| {{WikiDoc Sources}} | | {{WS}} |