Campos Amico Enio, de Souza Izadora K, Grigório Trigueiro Juliana R, Cunha Miranda Fernanda, Lacerda Sousa Rogério, de Araújo Lima Liguori Adriano
Department of Integrated Medicine, Federal University of Rio Grande do Norte/University Hospital Onofre Lopes, Natal, Rio Grande do Norte, Brazil.
Department of Integrated Medicine, Federal University of Rio Grande do Norte/University Hospital Onofre Lopes, Natal, Rio Grande do Norte, Brazil,
Dig Dis. 2019;37(4):309-314. doi: 10.1159/000496430. Epub 2019 Feb 14.
Focal nodular hyperplasia (FNH) is a frequent benign liver lesion. Its course is considered benign, and there is no recommendation for its treatment. Nevertheless, the literature presents a high incidence of surgery.
To evaluate the results of conservative treatment in a series of patients with presumed FNH.
The study included patients diagnosed with FNH from May 2007 to July 2017 based on conventional imaging or magnetic resonance imaging with liver-specific contrast (MRI-LSC) or lesion biopsy (histology/immunohistochemical analysis). Patients were followed clinically and using imaging exams.
In a total of 54 patients, the diagnosis was obtained by typical findings on computed tomography scan and gadolinium MRI in 48.1% of the patients, by MRI-LSC in 31.5%, and by histological examination in 20.4% of cases. The mean follow-up time was 35.5 months. The initially asymptomatic patients remained symptom-free, and none of those with HNF-related pain had to worsen of the initial symptom. Conservative treatment was effective in 94.4% of the cases. In only 3 cases, there was a need for some therapeutic approach (5.5%); 2 cases for pain and 1 case for lesion growth during follow-up.
The present study suggests that it is safe to conservatively manage patients with FNH presumed by highly accurate imaging tests. Similar to hepatic hemangiomas, surgery for FNH should be an exception.
局灶性结节性增生（FNH）是一种常见的肝脏良性病变。其病程被认为是良性的，且目前并无针对其治疗的推荐意见。然而，文献显示其手术发生率较高。
评估一系列疑似FNH患者的保守治疗结果。
该研究纳入了2007年5月至2017年7月期间基于传统影像学、肝脏特异性对比剂磁共振成像（MRI-LSC）或病变活检（组织学/免疫组化分析）诊断为FNH的患者。对患者进行临床随访并使用影像学检查。
总共54例患者中，48.1%的患者通过计算机断层扫描和钆增强MRI的典型表现确诊，31.5%通过MRI-LSC确诊，20.4%通过组织学检查确诊。平均随访时间为35.5个月。最初无症状的患者保持无症状，且所有有FNH相关疼痛的患者初始症状均未加重。保守治疗在94.4%的病例中有效。仅3例（5.5%）需要某种治疗方法；2例因疼痛，1例因随访期间病变生长。
本研究表明，对于通过高度准确的影像学检查推测为FNH的患者，进行保守治疗是安全的。与肝血管瘤类似，FNH的手术治疗应为例外情况。
