scholarly journals Diagnosis and treatment of benign liver nodules: Brazilian Society of Hepatology (SBH) recommendations

2015 ◽  
Vol 52 (suppl 1) ◽  
pp. 47-54 ◽  
Author(s):  
Edna Strauss ◽  
Adalgisa de Souza Paiva Ferreira ◽  
Alex Vianey Callado França ◽  
Andre Castro Lyra ◽  
Fabio Marinho do Rego Barros ◽  
...  
Keyword(s):  
Focal Nodular Hyperplasia ◽  
Anabolic Steroids ◽  
Hepatocellular Adenoma ◽  
Benign Tumors ◽  
Hormonal Stimulation ◽  
Central Scar ◽  
Oral Contraceptive Pills ◽  
Asymptomatic Patients ◽  
Adjacent Structures ◽  
Nodular Hyperplasia

ABSTRACT Space-occupying lessions of the liver may be cystic or solid. Ultrasonography is an extremely useful method for initial screening, and suffices for diagnosis of simple hepatic cysts. Complex cysts and solid masses require computed tomography or magnetic resonance imaging for confirmation. Wide surgical excision is indicated in cystadenoma or cystadenocarcinoma. Clinical and epidemiological data are important, as nodules in noncirrhotic livers are more likely to be benign. Hemangiomas, the most common benign tumors, require no follow-up after diagnostic confirmation if they are small and asymptomatic. Patients with giant, symptomatic hemangiomas or compression of adjacent structures should be referred to hepatobiliary centers for potential surgery. The genetic heterogeneity of hepatocellular adenoms and their epidemiology and prognosis prompted classification of these tumors into four subtypes based on histology and immunohistochemistry. The major complications of hepatocellular adenoms are rupture with bleeding and malignant transformation. Rupture occurs in approximately 30% of cases. The main risk factors are tumors size >5 cm and inflammatory subtype. Hepatocellular adenoms may enlarge during pregnancy due to marked hormonal stimulation. As oral contraceptive pills and anabolic steroids have associated with hepatocellular adenoms growth, particularly of the hepatocyte nuclear factor-1 alfa subtype, these drugs should be discontinued. Focal nodular hyperplasia is the second most common benign tumor of hte liver. It is most frequent in women aged 20 to 60, and 70% to 90% of cases are asymptomatic. In the adsence of a central scar and/or other hallmarks of Focal nodular hyperplasia, with uncertainty between this diagnosis and hepatocellular adenoma, liver-specific contrast agentes are indicated.

scholarly journals CONTRAST-ENCHANCED ULTRASOUND IN THE DIFFERENTIAL DIAGNOSIS OF FOCAL NODULAR HYPERPLASIA AND HEPATIC ADENOMA

2019 ◽  
Vol 26 (2) ◽  
pp. 50-63 ◽  
Author(s):  
Alexey N. Katrich ◽  
Nikolai S. Ryabinin ◽  
Sergey V. Polshikov ◽  
Nikita A. Katrich
Keyword(s):  
Differential Diagnosis ◽  
Contrast Agent ◽  
Focal Nodular Hyperplasia ◽  
Ultrasound Contrast Agent ◽  
Hepatocellular Adenoma ◽  
Morphological Data ◽  
Arterial Phase ◽  
Benign Tumors ◽  
Focal Lesions ◽  
Nodular Hyperplasia

Aim. To increase the effectiveness of the differential diagnosis of benign focal lesions of the liver using contrast-enhanced ultrasound (CEUS).Materials and methods. A retrospective analysis of the examination results of 37 patients with morphologically confi rmed liver benign tumors was carried out. According to the morphological data, the patients were divided into two groups: 22 patients with focal nodular hyperplasia (FNH) and 15 patients with hepatocellular adenoma (HCA). All the patients underwent multiparametric ultrasound examination using CEUS.Results. According to the obtained data, despite the nearly equal intensity of fi lling FNH and HCA with a contrast agent (96% and 80%, accordingly), FNH is characterized by an earlier contrasting (WASH IN) pattern in the arterial phase (AF), with the ‘onset of contrasting in the focus’ parameter being signifi cantly different from HCA (p<0.05). Specifi c signs of FNH included the following: the spoke-wheel pattern and an increased intensity of ultrasound contrast agent (USCA) accumulation — 96% of cases; ‘center-to-edge’ fi lling — 86% of cases. WASH-OUT is not a typical sign of FNA. A complete (100% of cases) and intensive (80% of cases) centripetal (80% of cases) fi lling is characteristic of HCA. No specifi c types of vascular pattern were observed. In 6 (40%) patients, WASH-OUT and ‘relative hyperechoic’ were detected in the portal phase.Conclusion. CEUS is established to be an effective method of the differential diagnosis of FNH and HCA. 

Intrapatient Comparison of the Hepatobiliary Phase of Gd-BOPTA and Gd-EOB-DTPA in the Differentiation of Hepatocellular Adenoma From Focal Nodular Hyperplasia

2018 ◽  
Vol 49 (3) ◽  
pp. 700-710 ◽  
Author(s):  
Inge J.S.M.L. Vanhooymissen ◽  
Maarten G. Thomeer ◽  
Loes M.M. Braun ◽  
Bibiche Gest ◽  
Sebastiaan van Koeverden ◽  
...  
Keyword(s):  
Focal Nodular Hyperplasia ◽  
Hepatocellular Adenoma ◽  
Hepatobiliary Phase ◽  
Nodular Hyperplasia

Value of Texture Analysis on Gadoxetic Acid–Enhanced MRI for Differentiating Hepatocellular Adenoma From Focal Nodular Hyperplasia

2019 ◽  
Vol 212 (3) ◽  
pp. 538-546 ◽  
Author(s):  
Roberto Cannella ◽  
Balasubramanya Rangaswamy ◽  
Marta I. Minervini ◽  
Amir A. Borhani ◽  
Allan Tsung ◽  
...  
Keyword(s):  
Texture Analysis ◽  
Focal Nodular Hyperplasia ◽  
Hepatocellular Adenoma ◽  
Gadoxetic Acid ◽  
Enhanced Mri ◽  
Nodular Hyperplasia

Hepatic Hemangioma, Focal Nodular Hyperplasia, and Hepatocellular Adenoma

2020 ◽  
pp. 3-48
Author(s):  
Luigi Grazioli ◽  
Barbara Frittoli ◽  
Roberta Ambrosini ◽  
Martina Bertuletti ◽  
Francesca Castagnoli
Keyword(s):  
Focal Nodular Hyperplasia ◽  
Hepatocellular Adenoma ◽  
Hepatic Hemangioma ◽  
Nodular Hyperplasia

scholarly journals Challenging liver lesions in noncirrhotic patients: Report of three cases

2019 ◽  
Vol 12 ◽  
pp. 263177451984494
Author(s):  
Tania Franceschini ◽  
Deborah Malvi ◽  
Lorenzo Maroni ◽  
Matteo Ravaioli ◽  
Matteo Cescon ◽  
...  
Keyword(s):  
Focal Nodular Hyperplasia ◽  
Hepatocellular Adenoma ◽  
Epithelioid Cell ◽  
Cell Tumor ◽  
Liver Lesions ◽  
Diagnostic Challenge ◽  
Radiological Features ◽  
Perivascular Epithelioid Cell ◽  
Nodular Hyperplasia ◽  
Final Histological Diagnosis

We describe three cases of liver lesions, characterized by a discrepancy between presurgical imaging and histological features, in which the final histological diagnosis was quite different from what the surgeons expected. We present (1) a case of primary liver angiomyolipoma associated with focal nodular hyperplasia, (2) a case of perivascular epithelioid cell tumor, and (3) a case of liver splenosis associated with focal nodular hyperplasia. In all cases, a presurgical diagnosis of hepatocellular adenoma was made. Due to nonspecific clinical and radiological features, these rare liver lesions are often presurgically misdiagnosed, especially in young noncirrhotic patients. The association among different lesions represents one additional diagnostic challenge.

Hepatocellular Adenoma and Focal Nodular Hyperplasia: Value of Gadoxetic Acid–enhanced MR Imaging in Differential Diagnosis

Radiology ◽  
2012 ◽  
Vol 262 (2) ◽  
pp. 520-529 ◽  
Author(s):  
Luigi Grazioli ◽  
Maria Pia Bondioni ◽  
Hiroki Haradome ◽  
Utaroh Motosugi ◽  
Rita Tinti ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Mr Imaging ◽  
Focal Nodular Hyperplasia ◽  
Hepatocellular Adenoma ◽  
Gadoxetic Acid ◽  
Nodular Hyperplasia

scholarly journals Liver Multiacinar Regenerative Nodules: Imaging Findings and Clinical Implications

2018 ◽  
Vol 31 (9) ◽  
pp. 470 ◽  
Author(s):  
Henrique Donato ◽  
Luísa Andrade ◽  
Nina Bastati ◽  
Augusta Cipriano ◽  
Ahmed Ba-Ssalamah ◽  
...  
Keyword(s):  
Focal Nodular Hyperplasia ◽  
Lesion Size ◽  
Clinical Settings ◽  
Hepatobiliary Phase ◽  
Imaging Features ◽  
Imaging Findings ◽  
Vascular Abnormality ◽  
Central Scar ◽  
Nodular Hyperplasia ◽  
Regenerative Nodules

Introduction: Multiacinar regenerative nodules are benign hepatocellular nodules related to vascular disturbances of the liver. They strongly resemble conventional focal nodular hyperplasia but are connected to different clinical settings, typically chronic liver disease. The purpose of the present study was to describe the key imaging features of these lesions and compare them with a control arm of focal nodular hyperplasia.Material and Methods: A blinded consensus review of liver magnetic resonance consisting of 26 cases of multiacinar regenerative nodules and 25 cases of focal nodular hyperplasia was performed. Lesion size, shape, margins, structure, T1 and T2 signal intensity, diffusion and contrast-enhanced features (including hepatobiliary phase), presence of a central scar and of a peripheral hypointense rim were compared between the two groups.Results: Significant differences between multiacinar regenerative nodules and focal nodular hyperplasia included size (median 2.35 cm, IQR: 2.13, vs 6.00 cm, IQR: 5.20, respectively, p < 0.001), presence of a peripheral hypointense rim after contrast (n = 9 vs n = 2 cases, p = 0.038) and of a central scar (n = 9 vs n = 20, p = 0.002). There were no other significant differences.Discussion: Overall multiacinar regenerative nodules and focal nodular hyperplasia have very similar imaging features but lack of a central scar and presence of a hypointense rim should suggest a diagnosis of multiacinar regenerative nodules.Conclusions: Recognition of the imaging findings of multiacinar regenerative nodules can explain some atypical cases of focal nodular hyperplasia, avoiding unnecessary biopsies. They may also be the trigger to investigate an unsuspected underlying liver vascular abnormality.

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