| Objective: To summarize our experiences on the diagnosis and treatment of hepatic focal nodular hyperplasia (FNH), and explore the diagnosis and treatment of FNH.Methods: Clinical data of 31 FNH patients, 13 of whom treated in the Affiliated Tumor Hospital of Guangxi Medical University from January 2000 to November 2009, and 18 treated in The First Affiliated Hospital of Guangxi Medical University from January 2003 to November 2009, were studied retrospectively with literature review, to summarize the clinical manifestations, laboratory tests, imaging, diagnosis and treatment of FNH. All patients were followed up till December 2009.Results: Of the 31 cases of FNH, 29 patients underwent hepatic resection and the diagnoses were confirmed by pathological examination, 2 cases were diagnosed by combination of biopsy and imaging tests. Among the 31 patients, 17 were male and 14 were female, with age from 12 to 63 years old. Mean age was 31 years old. All female patients had no history of long-term taking oral contraceptives. Most of the patients(74.2% ) had no obvious symptoms, 25 cases (80.6%) were young adults who were less than 40 years old. HBsAg was positive in one case, the rest were all negative. Most of the patients had normal liver functions. AFP,CA19-9 and other tumor markers were within the normal range in all the patients. Most of the lesions located in the left medial and the right anterior lobe of the liver , that is,â…£,â…¤,â…§hepatic segment (Table 2). Lesion sizes were between 0.5cm and 15.0cm, 77.1% (27/35) of which were not more than 5.0cm. And lesion sizes of symptomatic patient group were significantly greater than those of asymptomatic patient group (P <0.05).There was no significant difference in the lesion sizes between men and women (t = 1.048, P> 0.05).Twenty-seven patients (87%) had a single solitary focus and 4 had two lesions. The rate of correct diagnosis in this group was 0% by color Doppler ultrasound, 32.1% (9 / 28) by CT, 20% (2 / 10) by MRI, and 0% (0/3) by hepatic artery angiography. Correct preoperative diagnoses were made in only 3 cases (10.3%). 11 cases were misdiagnosed as liver cancer (37.9%), 4 misdiagnosed as hepatic adenoma, and 2 misdiagnosed as hepatic hemangioma. 9 cases had indefinite diagnoses. Treatment methods: 28 cases underwent hepatic resection, including one case with 2 lesions, of whom one lesion was surgically resected and had quick frozen pathologic examination, which prompted FNH, then the other one was not removed, treated conservatively. One case underwent laparoscopic surgical resection, and 2 cases were treated conservatively after the diagnoses were confirmed by the comprehensive utilization of biopsy and imaging tests. The incidence of surgical complications in this study was 13.8%, without operative mortality. Follow-up time was between 2 months to 6 years ,and all the patients suffered no relapses .Three patients who were treated conservatively, were followed up for 6 months to 53 months, and they were all alive, without significant changes in lesion sizes.Conclusion: Most patients of FNH have no clinical symptoms, and it's an effective method to improve the diagnostic accuracy of FNH by the comprehensive utilization and analysis of the imaging tests , such as contrast-enhanced ultrasonography , CT, MRI, radionuclide scanning, and so on.Asymptomatic patients of FNH , if the diagnoses are definite, may be treated conservatively and kept close observation. |
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