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Suspected focal nodular hyperplasia in male adults: 10-year experience from a large liver centre

  • Hepatobiliary
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Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

Focal nodular hyperplasia (FNH) is commonly found in females of reproductive age. In males, the diagnosis is made more cautiously due to its lower incidence and higher incidence of hepatocellular carcinoma, which can have overlapping imaging features. Follow-up or biopsy is sometimes required. This retrospective study aims to assess management of suspected FNH in male adult patients at our institution over a 10-year period.

Methods

Male adults (≥ 18 years) suspected of having FNH from January 2010—June 2020 were identified using a departmental radiology information system search. Data was collected from radiology reports and patient pathway manager.

Results

Of 342 patients with suspected FNH, 62 were male (18.1%; F:M of 4.5:1). We only included patients investigated and followed up by MRI, total of 57 patients. Median age was 40 years (range 18–74 years). Background liver disease present in 21/57 (36.8%), majority with hepatic steatosis. Average number of lesions per patient 1.7. 22/57 (38.6%) had at least one MRI follow-up using liver-specific contrast with 7 lesions demonstrating variation in size (range growth: -3.27 mm/year to + 4 mm/year). In 7 cases, MRI was not definitive; 6 required biopsy and 1 resection. Only 2/7 demonstrated malignancy. Of the total 57 patients, 6 have deceased and none due to a misdiagnosed or mismanaged hepatic lesion.

Conclusion

FNH is relatively uncommon in males, however, our data suggests that lesions with typical MRI characteristics do not require follow-up and diagnosis can be made confidently, similar to females. Any atypical features should prompt a biopsy.

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References

  1. Vilgrain V, Uzan F, Brancatelli G et al (2003) Prevalence of hepatic hemangioma in patients with focal nodular hyperplasia: MR imaging analysis. Radiology 229:75–79

    Article  PubMed  Google Scholar 

  2. Bröker MEE, Klompenhouwer AJ, Gaspersz MP, Alleleyn AME, Dwarkasing RS, Pieters IC, de Man RA, IJzermans JNM. Growth of Focal Nodular Hyperplasia is Not a Reason for Surgical Intervention, but Patients Should be Referred to a Tertiary Referral Centre. World J Surg. 2018 May;42(5):1506-1513.

    Article  PubMed  Google Scholar 

  3. Craig JR, Peters RL, Edmondson HA. Tumors of the liver and intrahepatic bile ducts. In: Armed Forces Institute of Pathology, editor. Atlas of tumor pathology, second series fascicle. Washington: Armed Forces Institute of Pathology; 1989. p. 26.

  4. Vilgrain V. Focal nodular hyperplasia. Eur J Radiol. 2006 May;58(2):236-45. doi: https://doi.org/10.1016/j.ejrad.2005.11.043. Epub 2006 Jan 18. PMID: 16414229.

    Article  PubMed  Google Scholar 

  5. Nguyen BN, Fl´ejou JF, Terris B, Belghiti J, Degott C. Focal nodular hyperplasia of the liver: a comprehensive pathologic study of 305 lesions and recognition of new histologic forms. Am J Surg Pathol 1999;23:1441–54.

    Article  CAS  PubMed  Google Scholar 

  6. Rebouissou S, Bioulac-Sage P, Zucman-Rossi J. Molecular pathogenesis of focal nodular hyperplasia and hepatocellular adenoma. J Hepatol. 2008;48:163–170

    Article  CAS  PubMed  Google Scholar 

  7. Vilgrain V (2006) Focal nodular hyperplasia. Eur J Radiol 58:236–245

    Article  PubMed  Google Scholar 

  8. Luciani A, Kobeiter H, Maison P et al (2002) Focal nodular hyperplasia of the liver in men: is presentation the same in men and women? Gut 50:877–880

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Kim MJ, Lim HK, Kim SH, et al. Evaluation of hepatic focal nodular hyperplasia with contrast-enhanced gray scale harmonic sonography: initial experience. J Ultrasound Med 2004;23:297–305.

    Article  PubMed  Google Scholar 

  10. Dill-Macky MJ, Burns PN, Khalili K, Wilson SR. Focal hepatic masses: enhancement patterns with SH U 508A and pulse inversion US. Radiology 2002;222:95e102.

    Article  Google Scholar 

  11. Bartolotta TV, Taibbi A, Brancatelli G, Matranga D, Tumbarello M, Midiri M, Lagalla R. Imaging findings of hepatic focal nodular hyperplasia in men and women: are they really different? Radiol Med. 2014 Apr;119(4):222-30.

    Article  PubMed  Google Scholar 

  12. Hamada K, Saitoh S, Nishino N, Fukushima D, Techigawara K, Koyanagi R, Horikawa Y, Shiwa Y, Sakuma H, Kondo F. An elderly man with progressive focal nodular hyperplasia. Clin J Gastroenterol. 2020 Jun;13(3):413-420.

    Article  PubMed  Google Scholar 

  13. Fujita N, Nishie A, Asayama Y, Ishigami K, Ushijima Y, Kakihara D, Nakayama T, Morita K, Ishimatsu K, Honda H. Hyperintense Liver Masses at Hepatobiliary Phase Gadoxetic Acid-enhanced MRI: Imaging Appearances and Clinical Importance. Radiographics. 2020 Jan-Feb;40(1):72-94.

    Article  PubMed  Google Scholar 

  14. Quaglia A, Tibballs J, Grasso A et al. Focal nodular hyperplasia-like areas in cirrhosis. Histopathology 2003; 42(1):14–21.

    Article  CAS  PubMed  Google Scholar 

  15. Ronot M, Bahrami S, Calderaro J, et al. Hepatocellular adenomas: accuracy of magnetic resonance imaging and liver biopsy in subtype classification. Hepatology 2011; 53: 1182–91.

    Article  PubMed  Google Scholar 

  16. Park MJ, Kim YK, Lee MW, Lee WJ, Kim YS, Kim SH, Choi D, Rhim H. Small hepatocellular carcinomas: improved sensitivity by combining gadoxetic acid-enhanced and diffusion-weighted MR imaging patterns. Radiology. 2012 Sep;264(3):761-70.

    Article  PubMed  Google Scholar 

  17. Grazioli L, Bondioni MP, Haradome H, et al. Hepatocellular adenoma and focal nodular hyperplasia: value of gadoxetic acid-enhanced MR imaging in differential diagnosis. Radiology 2012; 262: 520–9.

    Article  PubMed  Google Scholar 

  18. Kierans AS, Kang SK, Rosenkrantz AB. The Diagnostic Performance of Dynamic Contrast-enhanced MR Imaging for Detection of Small Hepatocellular Carcinoma Measuring Up to 2 cm: A Meta-Analysis. Radiology. 2016 Jan;278(1):82-94.

    Article  PubMed  Google Scholar 

  19. Kogita S, Imai Y, Okada M, et al. Gd-EOB-DTPAenhanced magnetic resonance images of hepatocellular carcinoma: correlation with histological grading and portal blood flow. Eur Radiol 2010; 10:2405–2413

    Article  Google Scholar 

  20. Lee MH, Kim SH, Park MJ, Park CK, Rhim H. Gadoxetic acid-enhanced hepatobiliary phase MRI and high-b-value diffusion-weighted imaging to distinguish well-differentiated hepatocellular carcinomas from benign nodules in patients with chronic liver disease. AJR Am J Roentgenol. 2011 Nov;197(5):W868-75.

    Article  PubMed  Google Scholar 

  21. Ueno A, Masugi Y, Yamazaki K, Komuta M, Effendi K, Tanami Y, et al. OATP1B3 expression is strongly associated with Wnt/β-catenin signalling and represents the transporter of gadoxetic acid in hepatocellular carcinoma. J Hepatol. 2014;61:1080–1087.

    Article  CAS  PubMed  Google Scholar 

  22. Ba-Ssalamah A, Antunes C, Feier D, Bastati N, Hodge JC, Stift J, Cipriano MA, Wrba F, Trauner M, Herold CJ, Caseiro-Alves F. Morphologic and Molecular Features of Hepatocellular Adenoma with Gadoxetic Acid-enhanced MR Imaging. Radiology. 2015 Oct;277(1):104-13. doi: https://doi.org/10.1148/radiol.2015142366. Epub 2015 May 18. PMID: 25985059.

    Article  PubMed  Google Scholar 

  23. Zech CJ, Grazioli L, Breuer J, Reiser MF, Schoenberg SO. Diagnostic performance and description of morphological features of focal nodular hyperplasia in Gd-EOB-DTPAenhanced liver magnetic resonance imaging: results of a multicenter trial. Invest Radiol 2008; 43: 504–11.

    Article  PubMed  Google Scholar 

  24. Kim YY, Park MS, Aljoqiman KS, Choi JY, Kim MJ. Gadoxetic acid-enhanced magnetic resonance imaging: Hepatocellular carcinoma and mimickers. Clin Mol Hepatol. 2019;25(3):223-233.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Beckett Street Harehills, Leeds, LS9 7TF, UK

    Carmelo Corallo, Joshua Bell, Adam Laverty, Maryam Mohsin & Raneem Albazaz

  2. Department of Hepatobiliary and Transplant Surgery, Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Leeds, UK

    Raj Prasad

Authors
  1. Carmelo Corallo
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  2. Joshua Bell
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  3. Adam Laverty
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  4. Maryam Mohsin
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  5. Raj Prasad
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  6. Raneem Albazaz
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Correspondence to Carmelo Corallo.

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The authors have no competing interests to disclose.

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Institutional Review Board approval was not required due to the retrospective nature of this study.

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Written informed consent was not required due to the retrospective nature of this study.

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Corallo, C., Bell, J., Laverty, A. et al. Suspected focal nodular hyperplasia in male adults: 10-year experience from a large liver centre. Abdom Radiol 48, 2292–2301 (2023). https://doi.org/10.1007/s00261-023-03896-z

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  • DOI: https://doi.org/10.1007/s00261-023-03896-z

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