肝癌误诊为肝脏局灶性结节性增生5例临床分析

目的分析5例肝癌误诊为肝脏局灶性结节性增生(FNH)的原因,探讨FNH与肝癌的鉴别诊断。方法回顾性分析2008年1月-2011年12月间术前误诊为FNH的5例肝癌患者的临床资料。结果彩超检查发现肝内低回声或不均质回声肿物,增强CT检查3例,增强MRI检查2例,部分病例可见中央瘢痕。术前诊断为FNH,所有病例均行手术切除,病理为肝细胞癌。结论合并肝炎时诊断FNH一定谨慎,正确应用和分析增强CT和MRI检查是诊断正确的关键。     

肝脏局灶性结节性增生

肝脏局灶性结节性增生(Focal Nod-ular Hyper plasia,简称 FNH)是肝脏少见的良性占位性病变。到目前为止,国内见诸报告的不多,在国外,七十年代以后对本     

常规超声及超声造影对肝局灶性结节性增生的诊断价值

正肝局灶性结节性增生(focal nodular hyperplasia,FNH)是由美国医生Edmondson于1858年首次提出的,定义为由良性或者接近良性的肝细胞增殖所形成的结节。1975年及次年分别被世界卫生组织与国际肝脏研究协会采纳,1995年国际工作组将FNH列为一类增生性病变。由于FNH缺乏特征性的二维超声表现,所以容易漏诊和误诊。本研究回顾性分析了FNH病例二维图像及超声造影图像表现与特点,探讨二维超声、彩色多普勒及超声造影对FNH的诊断价值,旨在提高FNH的诊断及     

儿童肝脏巨大局灶性结节性增生的诊治

目的探讨儿童肝脏巨大局灶性结节性增生的临床特征、诊断与治疗。方法对6例肝脏巨大局灶性结节性增生患儿术前均行腹部B超、增强CT及血清甲胎蛋白(AFP)检查。2例行肝Ⅴ～Ⅵ段切除术,2例行肝左外叶切除术,2例行肝左三叶切除术。结果 6例患儿均顺利完成手术,无并发症发生,术后5～7d痊愈出院。所有患儿随访6～14个月,腹部B超检查无肿瘤复发。复查血清AFP均正常,患儿生长发育良好。结论儿童肝脏巨大局灶性结节性增生临床上易与肝脏恶性肿瘤混淆。外科手术是最佳治疗方法,且肿瘤完整切除后,很少复发,但仍需定期随访。     

肝脏局灶性结节性增生1例

患者,男性,37岁,因"乏力、纳差、尿黄、右胁部闷痛不适1月余"入院.查体:生命体征平稳,神清,表情轻度痛苦,无贫血貌,全身皮肤、巩膜无黄染,无皮疹、出血点及瘀斑,胸前皮肤有蜘蛛痣,未见肝掌.浅表淋巴结未触及.面色无晦暗,颈软,心肺无明显异常发现.腹部不平,右上腹轻度隆起,未见腹壁静脉曲张,腹肌软,右上腹压痛,无反跳痛,肝肋下2.3 cm,质较硬,表面较平,触痛,脾肋下未触及,墨菲氏征阴性,肝浊音界无缩小,肝区叩痛,腹部无移动性浊音,双下肢无水肿.实验室检查:乙型肝炎病毒标志物抗HBs阳性、抗HBe阳性、抗HBc阳性.     

肝局灶性结节性增生

1 定义和流行病学 肝局灶性结节性增生(focal nodular hyperplasia,FNH)是一种发病率仅次于肝血管瘤的常见肝脏良性疾病,其特点为结节性增生性肝损害。FNH以妇     

肝脏局灶性结节增生1例

肝脏局灶性结节状增生(focal nodularhyperplasia,FNH)临床少见,本文报道1例女性患者,因“体检发现肝脏占位4 d多”入院,常规体检行计算机断层扫描检查提示肝脏占位:肝细胞腺瘤?行手术探查及术后病理检查提示局灶性结节状增生,术后随访9mo,无复发及转移.本文系统探讨FNH的病因、发病机制、鉴别诊断及治疗等.     

肝细胞局灶性结节性增生一例

患者女性，２５岁。体检发现肝占位病变３周收住院。Ｂ超、ＣＴ均证实肝占位病变，６ｃｍ ｘ ６ｃｍ大小。ＭＲＩ报告：肝左叶占位，考虑肝腺瘤或血管瘤。患者曾服用避孕药“马福隆”半年。术中见肿物位于肝左内叶，直径约６ｃｍ，质硬，部分已突至肝被膜表面。 病理检查巨检：不整形肝组织一块，大小１０ｃｍｘ８ｃｍ ｘ ７ｃｍ，切面见一肿物，直径约 ６ｃｍ，边界清，无包膜，浅棕色，较周围正常肝组织颜色淡。病灶中间为星形疤痕组织，纤维间隔从中央向周围将病灶分隔成结节状。镜检：病变由中心的星状疤痕和周围增生的肝细胞结节构成，…     

肝脏局灶性结节性增生46例临床分析

目的 研究肝脏局灶性结节性增生(FNH)临床及病理组化表现,旨在提高其诊断治疗水平.方法 回顾分析2000～2005年第二军医大学东方肝胆医院46例经病理证实FNH病例的临床、影像学、病理和免疫组化资料.结果 共46例FNH患者,均为单发;男性28例,女性18例,平均年龄35.5岁;病灶位于右叶28例,左叶13例,中肝叶4例,尾状叶1例;病灶直径1.3～10 cm,平均4.34 cm;术前诊断与术后病理相符者15例(32.61%),2例经肝脏穿刺活检病理诊断为FNH;术前误诊为原发性肝细胞癌24例(52.17%),误诊为肝细胞腺瘤2例(4.35%),误诊为肝血管瘤3例(6.52%);免疫组化:CD 34、CK 18、pCEA、Hep-1均为阳性,CA 19-9、P53均为阴性,CK 19阳性21例,PCNA阳性18例.结论 多数FNH不需手术治疗,但由于与HCA、HCC等疾病难以鉴别,大部分患者经外科手术切除后病理证实,故术前鉴别诊断十分重要,合理检查提高疾病诊断率是关键.     

肝脏局灶性结节性增生的诊治:附5例病例报告

目的讨论肝脏局灶性结节性增生的诊治特点。方法总结我科自1999年7月至2005年7月所收治的5例肝脏局灶性结节性增生病例,结合1994年至2005年国内有关文献,分析病史、实验室检查、影像学检查及治疗效果。结果本组5例病人均无自觉症状,肝功能、AFP正常,均行肝部分切除手术,病理诊断证实为肝脏局灶性结节性增生,术后转归良好。结论肝脏局灶性结节性增生发病机制尚不清楚,联合应用多种影像学检查有助于明确诊断;对诊断不明确病例仍应手术探查。     

Symptomatic focal nodular hyperplasia during pregnancy: a case report

A 30-year-old woman presented with hepatomegaly and an audible hepatic bruit at 24 weeks gestation. Non-contrast MRI demonstrated an exophytic 12.6 x 7.8 x 12.8 cm mass arising from the right lobe of the liver with a central scar, suggestive of focal nodular hyperplasia (FNH). Conservative management included monthly abdominal ultrasound examinations until the time of delivery, to assess growth of the mass and monitor for risk of rupture. Seven weeks post partum the patient experienced severe right upper quadrant pain. A CT angiogram of the liver demonstrated a stable mass with no evidence of bleed or rupture and multiple hypervascular masses throughout the liver. Surgical resection of the dominant lesion was performed. Histological examination of the lesion confirmed FNH. The patient is now 22 months post surgery with radiographic evidence of stable multifocal FNH.     

Hepatocellular carcinoma and focal nodular hyperplasia associated with norethandrolone-therapy: A case report

Summary A 33-year-old woman was treated for severe aplastic anemia with norethandrolone over a period of four years, with a cumulative dose of 25 g. In the fifth year of therapy two intrahepatic tumors were detected and were classified as hepatocellular carcinoma and as focal nodular hyperplasia, respectively.     

Atypical focal nodular hyperplasia of the liver

BACKGROUND:Focal nodular hyperplasia,a benign hepatic tumor,is usually asymptomatic.However,rarely the entity can cause symptoms,mandating intervention. METHOD:We present a case of focal nodular hyperplasia of the liver,which caused a considerable diagnostic dilemma due to its atypical presentation. RESULTS:A 29-year-old woman presented with a 15-year history of a progressively increasing mass in the right upper quadrant which was associated with pain and emesis. Examination showed a firm,mobile mass palpab...     

A case of multiple focal nodular hyperplasia in the liver which developed after heart transplantation

An 18-year-old woman, who had undergone cardiac allograft transplantation, developed continuous back pain two months after surgery. Abdominal computed tomography showed multiple enhanced lesions in her liver, which were not present before transplantation. One tumor bulged from the surface of the liver and compressed the stomach. Partial resection of the liver was performed and her symptoms improved. The pathological diagnosis was focal nodular hyperplasia (FNH). To our knowledge, this is the first report of multiple FNH after heart transplantation. Transplant clinicians may need to keep this possibility under consideration following heart transplantation.     

Cholestatic features in focal nodular hyperplasia of the liver

Twenty specimens of focal nodular hyperplasia were studied with special attention to the histological features of chronic cholestasis (grouped under the headings of cholestasis, cholate-stasis and signs of ductular reabsorption). In all specimens, evidence was found for one or more features of cholestasis and cholate-stasis. Signs of ductular reabsorption were less constant, and apparently varied according to the developmental stage of the lesion. The cholestatic features emphasize the bile secretory capacity of the lesional parenchyma, and are apparently due to the lack of real bile ducts in the portal tract equivalents of the lesional tissue. Evidence is presented that the "ductular component" in FNH is not due to proliferation of pre-existing ductules, but rather derives from ductular metaplasia of liver cell plates in zone 1 equivalents. This metaplastic development of a ductular network may serve the function of reabsorbing the biliary constituents produced by the lesional parenchyma, leading to periductular inflammation and progressive fibrosis, thus producing an equivalent of biliary fibrosis and biliary cirrhosis.     

Spontaneous regression of focal nodular hyperplasia of the liver

Focal nodular hyperplasia (FNH) of the liver is a rare benign lesion that probably reflects a local hyperplastic response of hepatocytes to a vascular abnormality. Currently, the natural history of the disease remains largely unknown. We present a patient with FNH of the liver who was followed up for 4 years. A 22-year-old woman with a 3-year history of oral contraceptive use was referred to our hospital in September 1996 for further examination of a liver tumor. A diagnosis of FNH was made using various imaging methods, such as ultrasonography, enhanced computed tomography (CT) scanning, MR imaging, and hepatic angiography, as well as fine-needle biopsy. A decrease in the size of the lesion was observed by enhanced CT scanning during the 4-year observation period. In this patient, oral contraceptive use and its discontinuation may have influenced the natural history of FNH. The present case suggests that an accurate diagnosis is of the utmost importance, and a patient with FNH should be managed conservatively rather than by resection, because FNH has the potential for spontaneous regression with the discontinuation of oral contraceptives. Received: March 13, 2001 / Accepted: June 22, 2001 Reprint requests to: K. Ohmoto     

The pathogenesis of focal nodular hyperplasia of the liver

Abstract   The pathogenesis of focal nodular hyperplasia is poorly understood. The lesion has been reported adjacent to many other focal hepatic lesions suggesting this is a nonspecific reaction to injury. Recent evidence suggests that arterio-venous shunt formation may trigger a positive feedback loop that includes hepatocellular hyperplasia.     

On the pathogenesis of focal nodular hyperplasia of the liver

Fifty-one focal nodular hyperplasia lesions from 36 patients were examined histologically. Serial sections and three-dimensional models were studied in selected cases. Lesions were multiple in 19% of patients. Thirty-four patients were female. One case had 11 focal nodular hyperplasia lesions and 7 hemangiomata in the liver. Three had astrocytoma and one had anomalous pulmonary venous drainage. Morphometric analysis revealed that the lesions were supplied by an anomalous artery larger than expected for the locale in the liver. This artery branched to form a spider-like structure and was usually not accompanied by a portal vein or duct. Each terminal arterial branch supplied a separate nodule 1 mm in diameter; adjacent nodules coalesced to form the focal nodular hyperplasia lesion. The arterial blood appeared to drain directly into the sinusoids of the nodule. We propose that focal nodular hyperplasia is an hyperplastic response of the hepatic parenchyma to a preexisting arterial spider-like malformation. The frequent coexistence of focal nodular hyperplasia with other vascular and neuroendocrine anomalies suggest that the malformations are developmental in origin. The basic requirement for development of hepatic hyperplasia may be greater blood flow to a region compared to the adjacent parenchyma. This requirement appears to be met in the other forms of nodular transformation of the liver, i.e., nodular regenerative hyperplasia and partial nodular transformation.     

Oral contraceptive use and focal nodular hyperplasia of the liver

BACKGROUND & AIMS: Because most patients with focal nodular hyperplasia (FNH) are young women, an important decision is whether to discontinue oral contraceptive (OC) use. The aims of this study were to evaluate (1) the number and size of FNH lesions in women with various patterns of OC use and in women without OC use and (2) the modifications in the number and size of FNH lesions during follow-up, according to OC use. METHODS: In a 9-year study in 216 women with FNH, the diameter and number of lesions documented by magnetic resonance (MR) imaging were evaluated (1) at diagnosis according to OC use as follows: group A, no OC use (n = 28); group B, high-dose OC use (n = 46); group C, low-dose OC use (n = 98); group D, successive use of high-dose and low-dose OCs (n = 33); and group E, use of progestogens only (n = 11); and (2) during follow-up in 136 women, 14 of whom were OC nonusers who stayed off OCs, 89 discontinued OC use, 26 took low-dose OCs, and 7 stayed on a progestogen only. Twelve women became pregnant. In 168 women, the diagnosis of FNH was made based on a combination of rigorously defined MR criteria. In the remaining 48 patients, diagnosis was by surgical biopsy (n = 36) or resection (n = 12). Mean diameter and number of lesion(s) per patient were assessed by MR imaging using the same protocol in all study patients. RESULTS: No significant differences in the number or size of lesions were found in the 5 patient groups. During follow-up, a change in lesion diameter occurred in only 4 women; this event was not influenced by OC use. In the 12 patients who became pregnant, lesion size was unchanged after delivery, pregnancy was uneventful, and delivery occurred spontaneously. CONCLUSIONS: These data suggest that (1) neither the size nor the number of FNH lesions are influenced by OC use; (2) size changes during follow-up are rare and do not seem to depend on OC use; and (3) pregnancy is not associated with FNH changes or complications.