Clinical Analysis Of Hepatic Focal Nodular Hyperplasia(a Report Of11Cases)

Objective To summarize clinical experience of hepatic focal nodularhyperplasia (FNH) and explore the diagnosis and treatment of FNH forimproving understanding of the disease.Methods Admitted to the Sino-Japanese Friendship Hospital of JilinUniversity from August2002to January2012,11cases of the history,clinical manifestations, imaging, pathology, diagnosis and treatment datawere retrospectively analyzed, and literature was reviewed.Results This group of patients have a total of11cases.9cases had asingle solitary focus and the others had two lesions. Two cases occurred inthe left hepatic lobe and the remaining lesions of9cases were located inthe right lobe, including5cases in the right anterior lobe of the liver.2cases of multiple lesions were located in the right lobe of the liver. Lesionsizes were between0.8cm and6.0cm,3cases of which were greater than5.0cm, the remaining lesions all less than5.0cm. There were5lesions ineach5males and the average diameter was2.90±0.98cm.6femalesincluded a total of eight lesions, with an average diameter of3.4±2.3cm(P>0.05). There was no significant difference in the lesion sizesbetween men and women.7cases of this group had symptom and theaverage lesion diameter was3.0±1.7cm. Four patients had no obvious symptoms with the average lesion diameter of3.5±2.2cm(P>0.05), so twogroups had no significant difference. Five cases were reported in themedical examination，one cases of which was suffering from ovarianchocolate cysts. Liver placeholder was found in physical examinationwith abdominal ultrasonography in preoperative, but no symptoms ofabdominal discomfort.5cases had abdominal pain and (or) abdominaldistension and discomfort, while the doctor found1cases due to fatigueyears after medical examination.5cases of women of childbearing age,the youngest21years old, maximum57years old, were denied long-termhistory of oral contraceptives.11cases underwent abdominal physicalexamination,4patients had right upper quadrant tenderness or mildtenderness, including one case associated with liver percussion pain；Twocases of patients were only liver percussion pain.2patients had palpableabdominal mass and3cases of abdominal were no positive signs. TheHBsAg of three cases were positive in laboratory tests, of which two casesof cirrhosis. Anti-HCV of the group were negative. AFP of11cases werenormal.6cases of laboratory CA19-9were in the normal range, but onefemale of CA19-9>1200U/ml，the others were not to make the check.6patients underwent CEA check, which being in the normal range. Themales of TSGF69u/ml slightly higher than normal. Liver function of3cases were abnormal, including two cases of bilirubin and convertingenzyme mildly elevated,1cases of which GGT significantly increased to 578IU/L. There were no obvious abnormalities in blood, urine, renalfunction and blood clotting conventional. This group of11casesunderwent abdominal ultrasound examination, ultrasound diagnosis rateof0%.10patients were underwent liver of CT (plain+Enhanced) check,2cases with central scar was diagnosed as FNH and1cases can not beruled out between FNH and liver cancer. There were not a clear diagnosisin the others cases and the coincidence rate was20.0%(2/10). Fourpatients underwent MRI，1of which was diagnosed as metastases and2cases diagnosed as liver cancer.1patient was considered for liver benignspace-occupying. The diagnosis rate was0%.10patients underwent opensurgical excision of the lesion,2patient of which underwentcholecystectomy for lesions being adjacent to the gallbladder or suferingfrom chronic cholecystitis. One case had two lesions, with the rightanterior lesion of liver having been resected on surgery and the rightposterior lobe tumors by absolute alcohol sclerotherapy. One patientdiagnosed by liver biopsy underwent liver microwave curing technique.Two cases were lost to follow after surgery and the others having beenfollowed up. The Follow-up time was from1month to9years, with norecurrence and metastases in patients of surgical resection.Conclusion FNH more frequently occurs in young patients withnon-specific symptoms, signs and laboratory parameters. The ultrasoundcan be used as a screening tool, and CT, MRI have a high diagnostic value of the check, especially those for typical lesions. If necessary, it can becombined with other methods, or biopsy to diagnosis. Asymptomaticpatients of FNH， if the diagnoses are definite, may be treatedconservatively or (and) kept close observation. The patients who haveclinical symptoms or preoperative diagnostic difficulties should be treatedsurgically.