Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea.
J Gastroenterol Hepatol. 2011 Jun;26(6):1004-9. doi: 10.1111/j.1440-1746.2011.06659.x.
Focal nodular hyperplasia (FNH) and FNH-like lesions are hypervascular masses that can mimic hepatocellular carcinoma (HCC). We have investigated the clinical, radiological and pathological features of FNH and FNH-like lesions of the liver, with particular focus on the aspect of diagnosis.
A total of 84 patients, 77 with pathologically-proven FNH and seven with FNH-like lesions of the liver, were analyzed retrospectively.
Of the 84 patients, seven had underlying liver cirrhosis, including two with Budd-Chiari syndrome and one with cardiac cirrhosis. These cases were therefore classified as having FNH-like lesions. Two of the remaining 77 patients without underlying liver cirrhosis were positive for hepatitis B surface antigen. Seven of 50 (14.0%) patients evaluated by four-phase computed tomography (CT) showed portal or delayed washout, and three of 28 (10.7%) patients analyzed by three-phase CT showed washout on the portal phase. Collectively, three of nine (33.3%) patients with risk factors for HCC could have been wrongly diagnosed with HCC based on the non-invasive diagnostic criteria for HCC. A central scar was observed in 30 patients (35.7%) radiologically. Among 62 patients who underwent percutaneous needle biopsy, four patients (6.5%) were misdiagnosed as having HCC and two patients (3.2%) had inconclusive results by a first needle biopsy.
The presence of a hepatic lesion with arterial hypervascularity and/or portal/delayed washout is not necessarily diagnostic of HCC, particularly in patients without risk factors for HCC. These radiological findings can also occur in cirrhotic patients with FNH-like lesions, including those with hepatic outflow obstruction.
局灶性结节性增生（FNH）和 FNH 样病变是富血管性肿块，可模拟肝细胞癌（HCC）。我们研究了肝脏 FNH 和 FNH 样病变的临床、放射学和病理学特征，特别关注诊断方面。
回顾性分析了 84 例经病理证实为 FNH 的患者（77 例）和 7 例 FNH 样肝病变患者。
84 例患者中，7 例存在基础肝硬化，其中 2 例为布加综合征，1 例为心源性肝硬化。因此，这些病例被归类为 FNH 样病变。在其余 77 例无基础肝硬化的患者中，有 2 例乙型肝炎表面抗原阳性。50 例患者中，有 7 例（14.0%）经四期 CT 评估显示门静脉或延迟性洗脱，28 例患者中有 3 例（10.7%）经三期 CT 分析显示门静脉期洗脱。总体而言，9 例（33.3%）有 HCC 风险因素的患者可能因 HCC 的非侵入性诊断标准而被误诊为 HCC。30 例患者（35.7%）放射学上可见中央瘢痕。在 62 例行经皮肝穿刺活检的患者中，有 4 例（6.5%）误诊为 HCC，首次活检有 2 例（3.2%）结果不确定。
存在富血管性肝病变和/或门静脉/延迟性洗脱不一定能诊断 HCC，特别是在无 HCC 风险因素的患者中。这些放射学发现也可发生在伴有 FNH 样病变的肝硬化患者中，包括肝流出道梗阻患者。
