Yang Fan, Peng Wenjing, Chen Shuang, Wan Lijuan, Zhao Rui, Liu Xiangchun, Ye Feng, Zhang Hongmei
Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 100021, Beijing, China.
Insights Imaging. 2024 Aug 26;15(1):215. doi: 10.1186/s13244-024-01793-7.
Newly detected hepatic nodules during follow-up of cancer survivors receiving chemotherapy may pose a diagnostic dilemma. We investigated a series of hepatic focal nodular hyperplasia (FNH) diagnosed by either typical MRI features and follow-up or pathology in cancer survivors.
This retrospective study evaluated 38 patients with tumours who developed new hepatic FNH after cyclophosphamide-based (n = 19) and oxaliplatin-based (n = 19) chemotherapies. The main tumour types were breast cancer (n = 18) and colorectal cancer (n = 17). MRI findings, clinical features, and temporal evolution of all target hepatic lesions (n = 63) were reported. In addition, the two chemotherapy drug groups were compared.
The median interval between chemotherapy completion and FNH detection was 30.4 months (12.9, 49.4). Six patients underwent biopsy or surgery, while the remaining patients were diagnosed based on typical MRI features and long-term follow-up. Among the patients, 60.5% (23/38) presented with multiple nodules and 63 target lesions were detected. The median size of target lesions was 11.5 mm (8.4, 15.1). The median follow-up time was 32.5 months (21.2, 48.6), and 15 patients experienced changes in their lesions during the follow-up period (11 increased and 4 decreased). The cyclophosphamide-based treatment group had a younger population, a greater proportion of females, and a shorter time to discovery than the oxaliplatin-based chemotherapy group (all p ≤ 0.016).
FNH may occur in cancer survivors after cyclophosphamide- or oxaliplatin-based chemotherapy. Considering a patient's treatment history and typical MRI findings can help avoid misdiagnosis and unnecessary invasive treatment.
When cancer survivors develop new hepatic nodules during follow-up, clinicians should think of the possibility of focal nodular hyperplasia in addition to liver metastasis, especially if the cancer survivors were previously treated with cyclophosphamide or oxaliplatin.
Cancer survivors, after chemotherapy, can develop hepatic focal nodular hyperplasia. Cyclophosphamide and oxaliplatin are two chemotherapeutic agents that predispose to focal nodular hyperplasia development. Focal nodular hyperplasia occurs at shorter intervals in patients treated with cyclophosphamide.
接受化疗的癌症幸存者在随访期间新发现的肝脏结节可能会带来诊断难题。我们调查了一系列通过典型MRI特征、随访或病理诊断为局灶性结节性增生（FNH）的癌症幸存者。
这项回顾性研究评估了38例在接受基于环磷酰胺（n = 19）和基于奥沙利铂（n = 19）的化疗后出现新的肝脏FNH的肿瘤患者。主要肿瘤类型为乳腺癌（n = 18）和结直肠癌（n = 17）。报告了所有目标肝脏病变（n = 63）的MRI表现、临床特征和时间演变情况。此外，对两个化疗药物组进行了比较。
化疗结束至发现FNH的中位间隔时间为30.4个月（12.9，49.4）。6例患者接受了活检或手术，其余患者根据典型MRI特征和长期随访进行诊断。在这些患者中，60.5%（23/38）出现多个结节，共检测到63个目标病变。目标病变的中位大小为11.5 mm（8.4，15.1）。中位随访时间为32.5个月（21.2，48.6），15例患者在随访期间病变出现变化（11例增大，4例减小）。与基于奥沙利铂的化疗组相比，基于环磷酰胺的治疗组患者更年轻，女性比例更高，发现时间更短（所有p≤0.016）。
FNH可能发生在接受基于环磷酰胺或奥沙利铂化疗的癌症幸存者中。考虑患者的治疗史和典型MRI表现有助于避免误诊和不必要的侵入性治疗。
当癌症幸存者在随访期间出现新的肝脏结节时，临床医生除了考虑肝转移外，还应想到局灶性结节性增生的可能性，特别是如果癌症幸存者之前接受过环磷酰胺或奥沙利铂治疗。
癌症幸存者化疗后可发生肝脏局灶性结节性增生。环磷酰胺和奥沙利铂是两种易引发局灶性结节性增生的化疗药物。接受环磷酰胺治疗的患者局灶性结节性增生出现的间隔时间更短。
