Tsalikidis Christos, Mitsala Athanasia, Pappas-Gogos George, Romanidis Konstantinos, Tsaroucha Alexandra K, Pitiakoudis Michail
Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece.
Laboratory of Experimental Surgery & Surgical Research, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece.
J Clin Med. 2023 Sep 18;12(18):6034. doi: 10.3390/jcm12186034.
Focal nodular hyperplasia (FNH) is the second most common benign hepatic tumor and can rarely present as an exophytic solitary mass attached to the liver by a stalk. Most FNH cases are usually detected as incidental findings during surgery, imaging or physical examination and have a high female predominance. However, the pedunculated forms of FNH are particularly rare and commonly associated with severe complications and diagnostic challenges. Hence, our study aims to provide a comprehensive summary of the available data on the pedunculated FNH cases among adults and children. Furthermore, we will highlight the role of different therapeutic options in treating this clinical entity. The use of imaging techniques is considered a significant addition to the diagnostic toolbox. Regarding the optimal treatment strategy, the main indications for surgery were the presence of symptoms, diagnostic uncertainty and increased risk of complications, based on the current literature. Herein, we also propose a management algorithm for patients with suspected FNH lesions. Therefore, a high index of suspicion and awareness of this pathology and its life-threatening complications, as an uncommon etiology of acute abdomen, is of utmost importance in order to achieve better clinical outcomes.
局灶性结节性增生（FNH）是第二常见的肝脏良性肿瘤，极少表现为通过蒂附着于肝脏的外生性孤立肿块。大多数FNH病例通常在手术、影像学检查或体格检查时作为偶然发现被检测到，且女性占比很高。然而，带蒂型FNH极为罕见，通常伴有严重并发症和诊断挑战。因此，我们的研究旨在全面总结成人和儿童带蒂FNH病例的现有数据。此外，我们将强调不同治疗方案在治疗这一临床实体中的作用。影像学技术的应用被认为是诊断工具箱的一项重要补充。关于最佳治疗策略，根据当前文献，手术的主要指征是出现症状、诊断不确定以及并发症风险增加。在此，我们还提出了疑似FNH病变患者的管理算法。因此，高度怀疑并认识到这种疾病及其危及生命的并发症（作为急性腹痛的罕见病因）对于获得更好的临床结果至关重要。
