| Objectives: In order to facilitate the diagnosis and treatment of hepatic focal nodular hyperplasia (FNH), the clinical and pathological features of FNH have been summarized, the connection between clinic and pathology of FNH also been researched in this paper.Methods: Forty-eight cases of the 2nd Affiliated Hospital of Kunming Medical University from February 2011 to December 2016 were retrospectively analyzed. The pathological features of FNH, such as gross examination, pathological type and character, immunohistochemistry, were summarized. The literature were reviewed.SPSS 19.0 Package was used to statistics and analysis.Results: 1，The group of 48 FNH cases had 21 female patients and 27 male patients with age from 7-60 years old,male to female ratio was 1.3, median age was 27.5 years old. Male patients had 30 lesion with mean diameter 4.2±1.7cm,and female patients had 22 lesion with mean diameter 5.0±2.0cm. There had no significant difference in the size of lesion between male and female (P>0.05). The age of 27 male patients ranged from 18～60 years old, with mean age 33.8±10.3. The age of 21 female patients ranged from 7～56 years old,with mean age 26.8±11.4. The mean age of male patients were older than female. There had significant difference in the age between male and female (P<0.05).A11 female patients in this group had no history of long-term oral contraceptives. The majority of patients (75%) had no clinically significant symptomatology, the lesion sizes of asymptomatic patients ranged from 1 to 9cm and the median size was 4cm. 12 patients (25%) felt abdominal pain , the lesion sizes of which ranged from 1.5 to 8cm and the median size was 4cm. There had no significant difference in the size of lesion between asymptomatic group and symptomatic group (P>0.05).2、The confirmed diagnostic rate of ultrasound was 7.1% (3/42), ultrasonic contrast was 100% (2/2),CT was 51.4% (19/37),MRI was 52.6% (10/19),and fine needle aspiration was 0% (0/2). Three patients (6.3%) were HBsAg positive and 2 patients (4.2%) were tumour marker abnormal. Twenty-six cases (54.2%) were deviant in liver function, other were normal in liver function and prothrombin time.3.Forty-four patients (91.7%) had single lesion, other 4 patients (8.3%) had two lesion. Twenty-eight lesions (53.8%) located in right lobe of liver. There had no significant difference in the size of lesion between left and right lobe of liver.Minimum and maximum diameter of lesions in this group were 1.0cm and 9.0cm. It had 40 lesions were well demarcated with surrounding liver tissue. Cut surface color of lesions were ashen,grayish yellow,taupe and grey white,and 26.9% cut surface was nodular, most of lesions were soft, tenacious and moderation. No capsule was found in 69.2% lesions. Central scar was found in 40.4% cut surface, and the size of lesion which had central scar was larger than the lesion which not found central scar.There had significant difference in the size of lesion between central scar and non central scar (P<0.05). About 9.6% lesions were haemorrhage and necrosis. The rate of central scar formation correlated significantly with the size of lesion (P<0.05), the greater diameter of lesion, the higher rate of central scar formation.4.Forty-seven cases (98.0%) were diagnosed as classical FNH in chronic appendicitis, and only 1 case (2.0%) was non-classical FNH which was mixed subtype and adenoma.Immunohistochemistry: in the group of classical FNH, 34 of 40 cases had strong positive expression of CK7/CK19 in small bile duct which proliferated in fibrous septa. All 40 cases had positive expression of CD34/CD31 in abnormal vessels of fibrous septum. All 40 cases had positive expression of CK8/CK18 in hepatocyte. 1 of 3 cases had positive expression of AFP. Proliferation index of 37 cases’ Ki67 was less than or equal to 5%, 2 cases were less than or equal to 10%, other 1 case was greater than 10%. In the group of non-classical FNH,CK7/CK19 expression is weakly positive in a small number of small bile duct. The case had positive expression of CK8/CK18 in hepatocyte, strong positive expression of CD34/CD31 in capillary in hepatocytes. Proliferation index of Ki67 in the case was less than or equal to 5%.5、Forty-eight patients all underwent hepatic resection: 17 cases (35.4%) treated by laparoscopic surgery, other 31 cases treated by laparotomy operation. The incidence of surgical complication was 14.9%, without operative deaths. All the patients had a good recovery after operation, and no recurrence happened.Conclusions: 1、FNH usually occurred in youth, and it showed no significant differences in FNH morbidity between men and woman, no direct relation to oral contraceptives. Patient usually had on obvious symptoms and signs, someone might feel epigastric pain.2、The imaging examination results of FNH showed that MRI and CT examination were sensitive than ultrasound. FNH detection rate could be raised through added liver imaging examination to ultrasound.3、FNH patients usually had single lesion and located in right lobe of liver. Most of lesions were less than or equal to 5.0cm in size. There had no significant difference in the size of lesion between left and right lobe of liver. The majority of lesions were well demarcated with surrounding liver tissue and not found envelope, haemorrhage or necrosis occurred relatively infrequent. Central scar was found in some cut surface of lesions. The diameter of all lesions with central scar was larger than 3.0cm. It shown that the probability of central scar might relate to the size of lesion.4、FNH pathology is mainly classical classical FNH, central scar, hepatocyte of lesion was broken up by fibrous septum and appeared nodular changes, thick wall or abnormal blood vessel, hyperplastic small bile duct could be found in fibrous septum under microscope. Non-classical FNH occurred less frequently.5、It should been distinguished non-classical FNH from HCA, hepatocellular carcinoma, and hepatic hemangioma.6.It should be more carefully distinguished FNH with liver cancer from reproducibility FNH nodules or FNH with HCC. It might confused liver cancer or liver cirrhosis with FNH, because fiber structure of scar, small bile duct proliferation and infiltration of chronic inflammatory cells could be found in the part of liver cancer or liver cirrhosis cases. So that the diagnosis of FNH should be connected with medical history, age, clinic and pathological character. |
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