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Yang F, Peng W, Chen S, Wan L, Zhao R, Liu X, Ye F, Zhang H. Hepatic focal nodular hyperplasia during follow-up of patients after cyclophosphamide- or oxaliplatin-based chemotherapy: differentiation from liver metastasis. Insights Imaging 2024; 15:215. [PMID: 39186145 PMCID: PMC11347512 DOI: 10.1186/s13244-024-01793-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 08/02/2024] [Indexed: 08/27/2024] Open
Abstract
OBJECTIVES Newly detected hepatic nodules during follow-up of cancer survivors receiving chemotherapy may pose a diagnostic dilemma. We investigated a series of hepatic focal nodular hyperplasia (FNH) diagnosed by either typical MRI features and follow-up or pathology in cancer survivors. METHODS This retrospective study evaluated 38 patients with tumours who developed new hepatic FNH after cyclophosphamide-based (n = 19) and oxaliplatin-based (n = 19) chemotherapies. The main tumour types were breast cancer (n = 18) and colorectal cancer (n = 17). MRI findings, clinical features, and temporal evolution of all target hepatic lesions (n = 63) were reported. In addition, the two chemotherapy drug groups were compared. RESULTS The median interval between chemotherapy completion and FNH detection was 30.4 months (12.9, 49.4). Six patients underwent biopsy or surgery, while the remaining patients were diagnosed based on typical MRI features and long-term follow-up. Among the patients, 60.5% (23/38) presented with multiple nodules and 63 target lesions were detected. The median size of target lesions was 11.5 mm (8.4, 15.1). The median follow-up time was 32.5 months (21.2, 48.6), and 15 patients experienced changes in their lesions during the follow-up period (11 increased and 4 decreased). The cyclophosphamide-based treatment group had a younger population, a greater proportion of females, and a shorter time to discovery than the oxaliplatin-based chemotherapy group (all p ≤ 0.016). CONCLUSIONS FNH may occur in cancer survivors after cyclophosphamide- or oxaliplatin-based chemotherapy. Considering a patient's treatment history and typical MRI findings can help avoid misdiagnosis and unnecessary invasive treatment. CLINICAL RELEVANCE STATEMENT When cancer survivors develop new hepatic nodules during follow-up, clinicians should think of the possibility of focal nodular hyperplasia in addition to liver metastasis, especially if the cancer survivors were previously treated with cyclophosphamide or oxaliplatin. KEY POINTS Cancer survivors, after chemotherapy, can develop hepatic focal nodular hyperplasia. Cyclophosphamide and oxaliplatin are two chemotherapeutic agents that predispose to focal nodular hyperplasia development. Focal nodular hyperplasia occurs at shorter intervals in patients treated with cyclophosphamide.
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Affiliation(s)
- Fan Yang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Wenjing Peng
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Shuang Chen
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Lijuan Wan
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Rui Zhao
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Xiangchun Liu
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Feng Ye
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China
| | - Hongmei Zhang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China.
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Mendes RR, Marques L, Figueiredo PC. Multiple Liver Nodules in Fontan-Associated Liver Disease. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2024; 31:70-72. [PMID: 38476301 PMCID: PMC10928859 DOI: 10.1159/000528462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/18/2022] [Indexed: 03/14/2024]
Affiliation(s)
- Raquel R. Mendes
- Department of Gastroenterology, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Luis Marques
- Department of Radiology, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Pedro C. Figueiredo
- Department of Gastroenterology, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
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Vahedifard F, Mortezazadeh M, Mofidi A, Kashani M, Sharifi Rayeni A. Focal nodular hyperplasia in a 14-year-old child: A case report. CASPIAN JOURNAL OF INTERNAL MEDICINE 2021; 12:S460-S463. [PMID: 34760105 PMCID: PMC8559645 DOI: 10.22088/cjim.12.0.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/27/2020] [Accepted: 01/09/2021] [Indexed: 10/31/2022]
Abstract
BACKGROUND Focal nodular hyperplasia (FNH) is a benign rare liver neoplasm in children and includes only 2% of all pediatric liver tumors. Here we reported the case of a 14-year-old girl with vague flank pain who was managed conservatively. CASE PRESENTATION Our case is a 14-year-old child (female), with a 5 cm diameter lesion in the right lobe of the liver in CT scan, and histologic findings compatible with FNH. A solid mass lobulated contour, intense enhancement with a hypodense central area, possibly indicative of central scar, was seen. Despite her mild flank pain we did not insist on surgical resection and managed her conservatively. Her pain resolved 2 weeks later and an imaging follow-up with ultrasound 6 months later showed no increase in size or numbers. CONCLUSION FNH is an uncommon mass lesion in children. Our patient had mild symptomatic severity, and several guidelines recommend surgical treatment in this condition, but our team performed conservative and medical treatment for her and got the desired result. Therefore, the combination of these factors raises the importance of introducing the case. According to FNH's nature, stability, complications, and evaluation of pain are essential to avoid unnecessary surgeries.
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Affiliation(s)
| | - Masoud Mortezazadeh
- Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran,Correspondence: Masoud Mortezazadeh, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. E-mail: , Tel: 0098 2166559957, Fax: 0098 2166559957
| | - Abbas Mofidi
- Faculty of Medicine, Iran university of Medical Sciences, Tehran, Iran
| | - Mehdi Kashani
- Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Sharifi Rayeni
- Department of Gastroenterology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Vernuccio F, Ronot M, Dioguardi Burgio M, Lebigot J, Allaham W, Aubé C, Brancatelli G, Vilgrain V. Uncommon evolutions and complications of common benign liver lesions. Abdom Radiol (NY) 2018; 43:2075-2096. [PMID: 29260281 DOI: 10.1007/s00261-017-1427-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Frequently encountered on abdominal imaging studies, the majority of common benign liver lesions are asymptomatic, confidently diagnosed by imaging, and do not require further workup, follow-up, or treatment. The increasing use of multimodality liver imaging, has allowed the recognition of uncommon evolutions of common benign liver lesions such as size changes, fibrotic regression, and content and vascularization changes, and their complications such as rupture, hemorrhage, thrombosis, extrinsic compression, and malignancy. The purpose of this pictorial review is to describe and illustrate the incidence and diagnostic features of these uncommon evolutions and complications on cross-sectional imaging, mainly on computed tomography and magnetic resonance imaging, with emphasis on those imaging clues which are helpful in the differential diagnosis or indicate the need for treatment.
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Busireddy KK, Ramalho M, AlObaidy M, Matos AP, Burke LM, Dale BM, Semelka RC. Multiple focal nodular hyperplasia: MRI features. Clin Imaging 2017; 49:89-96. [PMID: 29190518 DOI: 10.1016/j.clinimag.2017.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 11/19/2017] [Accepted: 11/21/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE To describe MRI features of multiple Focal Nodular Hyperplasia (FNHs). METHODS 40 consecutive subjects (37 females, mean age, 38.8years) were included. All studies were independently reviewed. This was an observational study to define the radiological features of multifocal FNH. RESULTS 130 lesions were evaluated. The majority (88.5%), were peripheral in location. 92.3% lesions were lobulated. Marked enhancement was present in 94.6% lesions. In the portal venous and delayed phase, 46.2% and 47.7% lesions were mildly hyperintense. Central scar was present in 77% lesions. CONCLUSIONS Distinctive features included predominant subcapsular location and mild hyperintensity in the delayed phase, seen in nearly 50% of FNHs.
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Affiliation(s)
- Kiran K Busireddy
- Department of Radiology, University of North Carolina at Chapel Hill, NC, USA
| | - Miguel Ramalho
- Department of Radiology, University of North Carolina at Chapel Hill, NC, USA; Department of Radiology, Hospital Garcia de Orta, Almada, Portugal
| | - Mamdoh AlObaidy
- Department of Radiology, University of North Carolina at Chapel Hill, NC, USA; Department of Radiology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - António P Matos
- Department of Radiology, University of North Carolina at Chapel Hill, NC, USA; Department of Radiology, Hospital Garcia de Orta, Almada, Portugal
| | - Lauren M Burke
- Department of Radiology, University of North Carolina at Chapel Hill, NC, USA
| | - Brian M Dale
- MR Research and Development, Siemens Medical Solutions, Morrisville, NC, USA
| | - Richard C Semelka
- Department of Radiology, University of North Carolina at Chapel Hill, NC, USA.
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Rozell JM, Catanzano T, Polansky SM, Rakita D, Fox L. Primary Liver Tumors in Pediatric Patients: Proper Imaging Technique for Diagnosis and Staging. Semin Ultrasound CT MR 2014; 35:382-93. [DOI: 10.1053/j.sult.2014.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Dynamic MRI Findings and Clinical Features of Benign Hypervascular Hepatic Nodules in Childhood-Cancer Survivors. AJR Am J Roentgenol 2013; 201:178-84. [DOI: 10.2214/ajr.12.9734] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Thoolen B, ten Kate FJ, van Diest PJ, Malarkey DE, Elmore SA, Maronpot RR. Comparative histomorphological review of rat and human hepatocellular proliferative lesions. J Toxicol Pathol 2012; 25:189-99. [PMID: 22988337 PMCID: PMC3434334 DOI: 10.1293/tox.25.189] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 05/24/2012] [Indexed: 02/07/2023] Open
Abstract
In this comparative review, histomorphological features of common nonneoplastic and neoplastic hepatocyte lesions of rats and humans are examined using H&E-stained slides. The morphological similarities and differences of both neoplastic (hepatocellular carcinoma and hepatocellular adenoma) and presumptive preneoplastic lesions (large and small cell change in humans and foci of cellular alteration in rats) are presented and discussed. There are major similarities in the diagnostic features, growth patterns and behavior of both rat and human hepatocellular proliferative lesions and in the process of hepatocarcinogenesis. Further study of presumptive preneoplastic lesions in humans and rats should help to further define their role in progression to hepatocellular neoplasia in both species.
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Affiliation(s)
- Bob Thoolen
- Global Pathology Support, Benoordenhoutseweg 23, 2596 BA The
Hague, The Netherlands
- University Medical Center Utrecht, PO Box 85500, 3508 GA
Utrecht, The Netherlands
| | - Fiebo J.W. ten Kate
- University Medical Center Utrecht, PO Box 85500, 3508 GA
Utrecht, The Netherlands
| | - Paul J. van Diest
- University Medical Center Utrecht, PO Box 85500, 3508 GA
Utrecht, The Netherlands
| | - David E. Malarkey
- National Toxicology Program, National Institute of
Environmental Health Sciences, Cellular and Molecular Pathology Branch,111 T.W. Alexander
Drive, NC 27709, USA
| | - Susan A. Elmore
- National Toxicology Program, National Institute of
Environmental Health Sciences, Cellular and Molecular Pathology Branch,111 T.W. Alexander
Drive, NC 27709, USA
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