Korean J Gastroenterol.  2014 Jul;64(1):49-53. 10.4166/kjg.2014.64.1.49.

Recurrence of Multiple Focal Nodular Hyperplasia in a Young Male Patient

• Chung E
• Park CH
• Kim J
• Han NI
• Lee YS
• Choi HJ
• Bae SH
• Park IY

• KMID: 1791895
• DOI: http://doi.org/10.4166/kjg.2014.64.1.49

Abstract

Focal nodular hyperplasia (FNH) is the second most common benign hepatic tumor that is usually found in women. Diagnosis of FNH mainly depends on imaging studies such as color Doppler flow imaging, computed tomography, and magnetic resonance imaging. It is characterized by the presence of stellate central scar and is nowadays incidentally diagnosed with increasing frequency due to advances in radiologic imaging technique. FNH typically presents as a single lesion in 70% of cases and generally does not progress to malignancy or recur after resection. Herein, we report a case of a young male patient with recurrent multiple FNH who underwent surgical resection for presumed hepatic adenoma on computed tomography.

Keyword

Focal nodular hyperplasia; Diagnosis

MeSH Terms

Adenoma, Liver Cell/diagnosis/pathology
Bile Ducts/pathology/surgery
Contrast Media/diagnostic use
Focal Nodular Hyperplasia/*diagnosis/pathology
Humans
Liver Neoplasms/*diagnosis/pathology
Magnetic Resonance Imaging
Male
Neoplasm Recurrence, Local
Tomography, X-Ray Computed
Young Adult
Contrast Media

Figure

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  Fig. 1. Three phase CT images showing ovoid heterogeneous masses that predominantly appear as hypoattenuating lesions on portal venous phase. (A, B) Prior to the first operation, the mass (white arrows) is located in the left lateral segment. (C, D) After 3 years, a new lesion is seen in segment 6 (asterisks).

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  Fig. 2. (A) Microscopic findings of the specimen from the first operation shows a non-encapsulated, well defined hepatocellular nodule (H&E,×40). (B) Within the nodule, arteries with thick wall (white arrow) and reactive bile ducts (white arrowhead) are seen (H&E, ×100). (C) The other specimen achieved after the second operation shows radiating fibrous septa (asterisks) dividing the tumor into nodules (H&E, ×40). (D) The hepatocytes in the nodular lesion without definite capsule shows no pleomorphism or cytologic atypia (black arrow) compared to normal parenchyma at the right (black arrowhead) (H&E, ×100).

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  Fig. 3. MRI taken during follow-up. (A, B) The lesion (white arrows) shows iso- and subtle high signal intensity compared to the adjacent liver parenchyma on arterial phase and low signal intensity on portal phase. (C, D) Small hypodense lesions (asterisks) with similar characteristics are seen in segment 4 on portal venous phase.

Reference

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