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Luo L, Wang T, Cheng M, Ge X, Song S, Zhu G, Xiao Y, Deng W, Xie J, Shan R. Rare benign liver tumors that require differentiation from hepatocellular carcinoma: focus on diagnosis and treatment. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04169-w. [PMID: 35789428 DOI: 10.1007/s00432-022-04169-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/21/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND/AIM Recently, an increase in the number of asymptomatic rare benign liver tumors (BLTs) has been reported during health check-ups. It is difficult to determine the nature of partial rare BLTs and not easy to distinguish from malignant liver tumors. This study aimed to analysis clinical features, diagnosis and treatment of rare BLTs to reduce misdiagnosis and provide reference for clinical practice. METHODS From January 2012 to January 2021, we treated 112 rare BLTs by hepatectomy, including 54 focal nodular hyperplasias, 14 hepatocellular adenomas, 28 hepatic angiomyolipomas, 3 hepatic granulomas, 2 inflammatory pseudotumors of the liver, 2 nodular regenerative hyperplasia, 2 hepatic lipomas, 1 solitary fibrous tumor of the liver, 1 hepatic schwannoma and 1 hepatic myelolipoma. RESULTS The majority of patients were middle-aged female and asymptomatic. Single tumors were dominant. The diagnostic accuracies of computed tomography (CT) and magnetic resonance imaging (MRI) were 32.5% and 44.2%, respectively. The majority of tumors were likely to be misdiagnosed as hepatocellular carcinoma (HCC) or difficult to distinguish from HCC. All patients underwent surgical treatment. Postoperative pathological and immunohistochemical examination can confirm the diagnosis. No patients without tumor recurrence or metastasis during follow-up period. CONCLUSION Altogether, the clinical symptoms of rare BLTs lack specificity, and their preoperative diagnosis largely depends on imaging examination, with a low diagnostic accuracy rate and high chances of misdiagnosis as HCC. Diagnosis is confirmed by pathological and immunohistochemical examination. Surgical resection for rare BLT is safe and effective, regular postoperative follow-up is necessary.
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Affiliation(s)
- Laihui Luo
- Department of General Surgery, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, China
| | - Tao Wang
- Department of Day Surgery Ward, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, China
| | - Mengting Cheng
- Department of General Surgery, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, China
| | - Xian Ge
- Department of Pathology, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, China
| | - Shengjiang Song
- Department of General Surgery, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, China
| | - Guoqing Zhu
- Department of General Surgery, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, China
| | - Yongqiang Xiao
- Department of General Surgery, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, China
| | - Wei Deng
- Department of General Surgery, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, China
| | - Jin Xie
- Department of General Surgery, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, China
| | - Renfeng Shan
- Department of General Surgery, First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, China.
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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 J Intern Med 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Ferreira R, Abreu P, Jeismann VB, Segatelli V, Coelho FF, David AI. Mucinous cystic neoplasm of the liver with biliary communication: case report and surgical therapeutic option. BMC Surg 2020; 20:328. [PMID: 33308210 PMCID: PMC7733287 DOI: 10.1186/s12893-020-01003-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/06/2020] [Indexed: 12/13/2022] Open
Abstract
Background Mucinous cyst neoplasm of the liver (MCN-L) comprise less than 5% of all cystic liver lesions and is characterized by the presence of ovarian stroma and absence of bile duct communication. Case presentation Here, we discuss a 45-year-old woman who presented with symptomatic liver mass. Diagnostic workup detected a 4.2 × 3.6 cm septate cyst located in segments I, V, and VIII of the liver in communication with the right hepatic duct. An open right liver resection with total bile duct excision and hilar lymphadenectomy was performed. Pathology revealed a multiloculated cyst with lined mucinous epithelium and ovarian-like stroma, consistent with low-grade MCN-L. Conclusions This case shows that unusual location and bile duct communication can be present in MCN-L.
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Affiliation(s)
- Raphaella Ferreira
- Division of Liver Surgery, Santa Casa of Sao Paulo School of Medical Sciences, São Paulo, Brazil
| | - Phillipe Abreu
- Division of Liver Surgery, Santa Casa of Sao Paulo School of Medical Sciences, São Paulo, Brazil. .,Department of Surgery, Jackson Memorial Hospital, Miami Transplant Institute, University of Mami, 1801 NW 9th Ave, 7th Floor, Miami, FL, 33137, USA.
| | - Vagner Birk Jeismann
- Division of Digestive Surgery, Department of Gastroenterology, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | - Vanderlei Segatelli
- Division of Clinical Pathology, Albert Einstein Israelite Hospital, São Paulo, Brazil
| | - Fabricio Ferreira Coelho
- Division of Digestive Surgery, Department of Gastroenterology, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | - Andre Ibrahim David
- Division of Liver Transplant Surgery, Samaritano Higienopolis Hospital, São Paulo, Brazil
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Ardito F, Aldrighetti L, Guglielmi A, Jovine E, Cillo U, Ferrero A, De Carlis L, Belli G, Dalla Valle R, Slim A, Mazzaferro V, Navarra G, Ettorre GM, Calise F, Pinna AD, Giuliante F; Italian Group of Minimally Invasive Liver Surgery (I Go MILS). Surgical Management of Hepatic Benign Disease: Have the Number of Liver Resections Increased in the Era of Minimally Invasive Approach? Analysis from the I Go MILS (Italian Group of Minimally Invasive Liver Surgery) Registry. J Gastrointest Surg 2020; 24:2233-43. [PMID: 31506894 DOI: 10.1007/s11605-019-04260-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 05/01/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Increased expertise with minimally invasive liver surgery (MILS) could cause an unjustified extension of indications to resect liver benign disease (BD). The aim of this study was to evaluate the operative risk of MILS for BD and if implementation and diffusion of MILS have widened indications for BD resection. METHODS A prospective study including centers with > 6 MILS for BD, enrolled in the I Go MILS registry from January 2015 to October 2016. Cysts fenestrations were excluded. RESULTS Eight hundred eighteen MILS were performed in 15 centers. One hundred seventy-three of these (21.1%) were for BD: conversion rate was 6.9%, postoperative mortality and morbidity rates were 0 and 13.9%. During the same period, 3713 liver resections (open + MILS) were performed and 407 (11.0%) were for BD. A time-trend analysis showed that the total number of MILS and the number of MILS for malignant disease significantly increased, but this increasing trend was not documented for the number of MILS for BD, which remained stable during the study period of time. This trend was confirmed for the overall rate of resected BD (open + MILS) that remained stable. DISCUSSION BD represents a valid indication for MILS. For BD, 21.1% of MILS was performed, rate significantly lower than that previously reported in Italy. Although an evident growth of the use of MILS was observed during the time period analysis in Italy, this trend did not correspond to an increased number of MILS for BD, and the overall rate of resected BD was comparable to that reported in previous large open series.
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Abstract
Background Due to the frequent use of medical imaging including ultrasonography, the incidence of benign liver tumors has increased. There is a large variety of different solid benign liver tumors, of which hemangioma, focal nodular hyperplasia (FNH), and hepatocellular adenoma (HCA) are the most frequent. Advanced imaging techniques allow precise diagnosis in most of the patients, which reduces the need for biopsies only to limited cases. Patients with benign liver tumors are mostly asymptomatic and do not need any kind of treatment. Symptoms can be abdominal pain and pressure effects on adjacent structures. The 2 most serious complications are bleeding and malignant transformation. Summary This review focuses on hepatic hemangioma (HH), FNH, and HCA, and provides an overview on clinical presentations, surgical and interventional treatment, as well as conservative management. Treatment options for HHs, if indicated, include liver resection, radiofrequency ablation, and transarterial catheter embolization, and should be carefully weighed against possible complications. FNH is the most frequent benign liver tumor without any risk of malignant transformation, and treatment should only be restricted to symptomatic patients. HCA is associated with the use of oral contraceptives or other steroid medications. Unlike other benign liver tumors, HCA may be complicated by malignant transformation. HCAs have been divided into 6 subtypes based on molecular and pathological features with different risk of complication. Key Message The vast majority of benign liver tumors remain asymptomatic, do not increase in size, and rarely need treatment. Biopsies are usually not needed as accurate diagnosis can be obtained using modern imaging techniques.
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Affiliation(s)
- Karl J Oldhafer
- Department für Chirurgie, Klinik für Leber-, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek, Hamburg, Germany.,Semmelweis University Budapest, Asklepios Campus Hamburg, Hamburg, Germany
| | - Victoria Habbel
- Department für Chirurgie, Klinik für Leber-, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek, Hamburg, Germany.,Semmelweis University Budapest, Asklepios Campus Hamburg, Hamburg, Germany
| | | | - Georgios Makridis
- Department für Chirurgie, Klinik für Leber-, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek, Hamburg, Germany.,Semmelweis University Budapest, Asklepios Campus Hamburg, Hamburg, Germany
| | - Kim Caroline Wagner
- Department für Chirurgie, Klinik für Leber-, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek, Hamburg, Germany.,Semmelweis University Budapest, Asklepios Campus Hamburg, Hamburg, Germany
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Abstract
This issue of Seminars in Pediatric Surgery reviews leading topics in pediatric hepatobiliary surgery where controversy exists and provides a learning resource to the subject.
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Affiliation(s)
- Mark Davenport
- Department of Paediatric Surgery, Kings College Hospital, Denmark Hill, London SE5 9RS, UK.
| | - Mikko Pakarinen
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group, Children's Hospital, Helsinki University hospital, University of Helsinki, Finland
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Abstract
Liver hemangiomas are the most common benign liver mass and typically asymptomatic and incidentally found. Giant liver hemangiomas are defined as having an overall diameter of >5 cm and more likely to be symptomatic. We present a case of a dominant caudate lobe hemangioma presented with weight loss and abdominal pain.
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Zhuang L, Ni C, Din W, Zhang F, Zhuang Y, Sun Y, Xi D. Huge focal nodular hyperplasia presenting in a 6-year-old child: A case presentation. Int J Surg Case Rep 2016; 29:76-79. [PMID: 27825058 PMCID: PMC5099262 DOI: 10.1016/j.ijscr.2016.10.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/23/2016] [Accepted: 10/23/2016] [Indexed: 11/28/2022] Open
Abstract
FNH is a benign lesion of the liver which is rare in children. We report the case of a 6-year-old child (male) with a huge FNH which size is more than 10 cm. This could be the biggest FNH among all children’s FNH cases ever reported. When pediatric FNH patients accord with (1) clinical symptoms; (2) indefinite diagnosis or hepatitis B virus carriage; (3) tumor size >5 cm, surgical treatment could be considered.
Introduction Focal nodular hyperplasia (FNH) is a benign lesion of the liver which is usually found in healthy adults, however, FNH is rare in children, and comprises only 2% of all pediatric liver tumors. Herein, we report the case of a 6-year-old child (male) with a huge FNH which size is more than 10 cm. This could be the biggest FNH among all children’s FNH cases ever reported. Case presentation A 6-year-old boy was found a hepatic space-occupying lesion two years ago. As the time went by, the lesion became bigger gradually. The last CT examination showed the size of the tumor to be 10.5 × 9.9 cm in the right hepatic lobe. This child underwent surgical resection of the tumor which was confirmed as FNH (11 × 8 × 7 cm) by pathology. Conclusion FNH is a benign lesion of the liver, and it is characterized by hepatocyte hyperplasia and a central stellate scar. It is uncommon for FNH to be diagnosed in children. Such huge FNH (about 11 cm) is extremely rare. Surgical operation may be the effective method to cure huge FNH.
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Affiliation(s)
- Lin Zhuang
- Department of General Surgery, Wujin Affiliated Hospital of Jiangsu University, Changzhou, 213161, China
| | - Chuangye Ni
- Department of Liver Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Wenbing Din
- Department of Liver Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Feng Zhang
- Department of Liver Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yi Zhuang
- Department of Emergency, Wujin Affiliated Hospital of Jiangsu University, Changzhou, 213161, China
| | - Yawei Sun
- Department of General Surgery, Wujin Affiliated Hospital of Jiangsu University, Changzhou, 213161, China
| | - Dong Xi
- Department of General Surgery, Wujin Affiliated Hospital of Jiangsu University, Changzhou, 213161, China.
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9
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Qureshi SS, Bhagat M, Kembhavi S, Vora T, Ramadwar M, Chinnaswamy G, Prasad M, Khanna N, Laskar S. Benign liver tumors in children: outcomes after resection. Pediatr Surg Int 2015; 31:1145-9. [PMID: 26263875 DOI: 10.1007/s00383-015-3763-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Benign liver tumors in children are rare and data regarding the surgical outcomes are deficient. We reviewed our experience in the management of these tumors particularly the extent, safety, and effectiveness of surgical resection. METHODS Between March 2005 and March 2014, 10/90 liver resections were performed for benign liver tumors. Three other patients received conservative treatment. Demographic characteristics, operative management, morbidity, and mortality were analyzed. RESULTS The median age of the patients was 12 months. The distribution of pathology was infantile hepatic hemangioendothelioma/hemangioma (n = 7), mesenchymal hamartoma (n = 4), adenoma (n = 1) and focal nodular hyperplasia (n = 1). Median tumor size was 12.25 cm (range 3.5-21 cm) with a median tumor volume of 576.64 cm(3) (range 13.9-1822.64 cm(3)). Non-anatomic resection was performed in 6/10 patients and the median blood loss was 100 ml (range 10-850 ml). Median length of hospital stay was 7 days (range 5-9 days). There were no mortality, none of the patients had a local recurrence, and all are alive at a median follow-up of 33 months. CONCLUSIONS Two-third patients with benign liver tumors were managed with surgical excision, which comprised 11% of our resectional practice. Non-anatomical resection whenever feasible can be performed safely and does not compromise the oncological outcomes.
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Affiliation(s)
- Sajid S Qureshi
- Division of Pediatric Surgical Oncology, Department of Surgical Oncology, Tata Memorial Centre, Ernest Borges Road, Parel, Bombay, 400012, India.
| | - Monica Bhagat
- Division of Pediatric Surgical Oncology, Department of Surgical Oncology, Tata Memorial Centre, Ernest Borges Road, Parel, Bombay, 400012, India
| | - Seema Kembhavi
- Department of Radiology, Tata Memorial Centre, Bombay, India
| | - Tushar Vora
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Centre, Bombay, India
| | - Mukta Ramadwar
- Department of Pathology, Tata Memorial Centre, Bombay, India
| | - Girish Chinnaswamy
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Centre, Bombay, India
| | - Maya Prasad
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Centre, Bombay, India
| | - Nehal Khanna
- Department of Radiation Oncology, Tata Memorial Centre, Bombay, India
| | - Sidharth Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Bombay, India
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Newhook TE, LaPar DJ, Lindberg JM, Bauer TW, Adams RB, Zaydfudim VM. Morbidity and mortality of hepatectomy for benign liver tumors. Am J Surg 2015; 211:102-8. [PMID: 26307421 DOI: 10.1016/j.amjsurg.2015.06.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 05/29/2015] [Accepted: 06/01/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND This study compared the morbidity and mortality following hepatectomy for benign liver tumors and hepatic metastases. METHODS This retrospective cohort study compared patients who underwent hepatectomy for benign liver tumors and metastases reported to National Surgical Quality Improvement Program between 2005 and 2011. RESULTS A total of 5,542 patients underwent hepatectomy: 1,164 (21%) for benign and 4,378 (79%) for metastatic diseases. Patients with benign tumors were younger, predominantly female, and were less likely to have preoperative comorbidities (all P < .037). Rates of major complications including infections, embolism, renal failure, stroke, coma, cardiac arrest, reoperation, and ventilator dependence were similar between the 2 groups (all P ≥ .05). Thirty-day mortality was .9% among patients with benign tumors and 1.4% among patients with metastases (P = .128). After adjusting for significant effects of age and major complications (both P ≤ .007), benign vs malignant diagnosis and extent of hepatectomy was not associated with 30-day survival (both P ≥ .083). CONCLUSIONS Despite patients with benign disease being younger and healthier, risks of major complications are similar after hepatectomy for benign and metastatic disease. Hepatectomy should be offered selectively for patients with benign liver tumors.
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Affiliation(s)
- Timothy E Newhook
- Section of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Virginia Health System, Box 800709, 1215 Lee Street, Charlottesville, VA 22908, USA
| | - Damien J LaPar
- Section of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Virginia Health System, Box 800709, 1215 Lee Street, Charlottesville, VA 22908, USA
| | - James M Lindberg
- Section of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Virginia Health System, Box 800709, 1215 Lee Street, Charlottesville, VA 22908, USA
| | - Todd W Bauer
- Section of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Virginia Health System, Box 800709, 1215 Lee Street, Charlottesville, VA 22908, USA
| | - Reid B Adams
- Section of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Virginia Health System, Box 800709, 1215 Lee Street, Charlottesville, VA 22908, USA
| | - Victor M Zaydfudim
- Section of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Virginia Health System, Box 800709, 1215 Lee Street, Charlottesville, VA 22908, USA.
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Ma IT, Rojas Y, Masand PM, Castro EC, Himes RW, Kim ES, Goss JA, Nuchtern JG, Finegold MJ, Thompson PA, Vasudevan SA. Focal nodular hyperplasia in children: an institutional experience with review of the literature. J Pediatr Surg 2015; 50:382-7. [PMID: 25746693 DOI: 10.1016/j.jpedsurg.2014.06.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 05/13/2014] [Accepted: 06/28/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Focal nodular hyperplasia (FNH) is uncommonly diagnosed in pediatric patients and may be difficult to distinguish from a malignancy. We present a review of all children with a tissue diagnosis of FNH at our institution, describe the diagnostic modalities, and provide recommendations for diagnosis and follow-up based on our experience and review of the literature. METHODS A retrospective review of children <18years of age diagnosed with FNH at a single institution was performed from 2000 to 2013. RESULTS Twelve patients were identified with a tissue diagnosis of FNH. Two patients required surgical resection of their lesion owing to concern for malignancy. Ten patients were managed expectantly with imaging surveillance after biopsy confirmed a diagnosis of FNH. All patients who underwent MRI had very typical findings including hypointensity on T1 weighted sequences, hyperintensity on T2, and homogenous uptake of contrast on the arterial phase. On follow-up all patients had either a stable lesion or reduction in size. CONCLUSIONS Focal nodular hyperplasia presents typically in children with liver disease, have undergone chemotherapy, and adolescent females. Young children, particularly <5years of age, without underlying liver disease or history of chemotherapy can pose a diagnostic dilemma. In this unique subgroup of children with FNH, MRI and/or needle biopsy should be adequate diagnostic modalities for these lesions.
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Affiliation(s)
- Irene T Ma
- Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Yesenia Rojas
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Prakash M Masand
- Department of Radiology, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Eumenia C Castro
- Department of Pathology, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Ryan W Himes
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Eugene S Kim
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - John A Goss
- Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Jed G Nuchtern
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Milton J Finegold
- Department of Pathology, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Patrick A Thompson
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Sanjeev A Vasudevan
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas.
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