Langrehr J M, Pfitzmann R, Hermann M, Radke C, Neuhaus P, Pech M, Denecke T, Felix R, Hänninen E L
Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany.
Acta Radiol. 2006 May;47(4):340-4. doi: 10.1080/02841850600570474.
To report the association between hepatocellular carcinoma (HCC) and hepatic focal nodular hyperplasia (FNH) and the possible impact on clinical decision-making with regard to resective approaches in patients with FNH.
We retrospectively analyzed the findings in 77 adult patients who underwent liver resections for FNH between October 1989 and September 2001 at our center. HCC within the confines of FNH was found in two patients. We demonstrate the magnetic resonance imaging (MRI) and macroscopic and microscopic findings.
Presurgical MRI demonstrated heterogeneous signal characteristics of moderately hyperintense FNH on T2-weighted images and, after i.v. administration of superparamagnetic iron oxide particles, HCC in FNH was barely delineable. Both patients underwent successful right hemihepatectomy to remove the suspicious FNH with diameters of 12 and 14 cm; intralesional HCC diameters were 3 and 5 cm, respectively. Patients could be rapidly dismissed. However, one patient died after recurrence of HCC 1.5 years after surgery, whereas the other patient continues tumor-free 4 years after surgery. Alpha-feto-protein was normal in both patients.
In FNH with rapid growth tendency and heterogenic MR appearance, surgical removal should be considered to overcome the risk of inadequate therapy in the very rare group of patients with HCC in association with FNH.
报告肝细胞癌（HCC）与肝局灶性结节性增生（FNH）之间的关联，以及其对FNH患者手术切除方法临床决策的可能影响。
我们回顾性分析了1989年10月至2001年9月期间在本中心因FNH接受肝切除术的77例成年患者的检查结果。在两名患者的FNH范围内发现了HCC。我们展示了磁共振成像（MRI）以及大体和显微镜检查结果。
术前MRI显示FNH在T2加权图像上呈中等高信号的不均匀信号特征，静脉注射超顺磁性氧化铁颗粒后，FNH中的HCC几乎无法分辨。两名患者均成功接受了右半肝切除术，以切除直径分别为12厘米和14厘米的可疑FNH；瘤内HCC直径分别为3厘米和5厘米。患者术后恢复迅速。然而，一名患者在术后1.5年HCC复发后死亡，而另一名患者术后4年无肿瘤复发。两名患者的甲胎蛋白均正常。
对于具有快速生长趋势且MRI表现异质性的FNH，应考虑手术切除，以克服极罕见的合并HCC的FNH患者治疗不足的风险。
