Clinicopathologic Features Of Focal Nodular Hyperplasia Of The Liver

Objective:To study focal nodular hyperplasia of the liver.It is difficult to differentiate FNH from well-differentiated hepatocellular carcinoma,cirrhosis of liver and regenerative nodules.Methods:From January 2010 to December 2022,the clinicopathological data of 23 patients with FNH and 3 patients with liver regenerative nodules(NRH)diagnosed by pathology in the First Affiliated Hospital of Wannan Medical College were obtained.The clinicopathological data of 40 cases of well-differentiated hepatocellular carcinoma and 40cases of cirrhosis of liver from January 2019 to December 2021 were collected.The clinicopathologic features of FNH were summarized through the analysis of clinical data and observation of pathological sections,including gross observation,Methods:The clinicopathological characteristics of FNH were compared with those of well-differentiated hepatocellular carcinoma,cirrhosis of liver and regenerative nodules.SPSS 26.0 was used for the totality analysis of the data.Results:1.There were 5 males and 18 females with FNH;The age range was 13-66 years,the average age was about 32.17 years,the median age was 29 years,there was no significant difference in age between the sexes(t=0.27,P>0.05).There was significant difference between clinical symptoms and age(t=7.19,P<0.05).2.There were 14 cases(60.9%)of FNH with pathological diagnosis in imaging examination.There was a significant difference between imaging diagnosis and pathological diagnosis and lesion diameter(t=3.91,P<0.05).3.The diameter of FNH was significantly different from the clinical symptoms(t=7.19,P<0.05).There were significant differences between the location of the lesion and the age(t=7.55,P<0.05),the diameter of the lesion and the gender(t=5.18,P<0.05).4.The lesion of FNH was divided into nodules of different sizes by fiber-like tissue under microscopy,which formed a dividing line with the surrounding liver tissue.There was no obvious or mild atypia of the cells.In about 2 cases(8.7%),abnormal vascular malformations were seen in typical fibrous thickened areas,some of which were thick-walled eccentric arteries with myxoid degeneration and inflammatory cell infiltration.5.The expression of GS was not significant in FNH,NRH,cirrhosis of liver and HHC(x~2=70.73,P>0.05).The expression of GPC-3 was negative in FNH,NRH,cirrhosis of liver and normal liver,but positive in HHC.In all cases of FNH,the three staining results complement each other,showing that the proportion of collagen fibers in the lesions is about3%-44%,the average proportion is about 20.6;The ratio of collagen fibers to diseased cells was significantly different in 10%and 15%(t=5.01,P<0.05;t=2.69,P<0.05),there was a significant correlation between the central scar and the proportion of collagenous fibers(Z=2.36,P<0.05),there was a correlation between the proportion of collagen fibers≥20%and the presence or absence of central scar(r=0.52,P<0.05).6.All cases of FNH underwent excision under gastroscope.Only one case showed a slight increase in AFP level at 7 after the operation,and then returned to the normal range at 3intervals.There were 2 female patients with polycystic ovary syndrome and oral progesterone therapy,but the serum progesterone level was not detected,and the age was<40 years old;All 23 patients denied having a history of oral contraceptives.Conclusion:1.FNH in women more than men,more occurred before the age of 40,laboratory results have no obvious specificity,imaging examination in most patients can be confirmed,there are still atypical cases need to rely on pathological diagnosis.2.FNH is mostly a single lesion,mostly in asymptomatic patients,and larger lesion in symptomatic patients,which may be related to the specific location of the lesion oppression of bile ducts and blood vessels.3.Central scar is one of the characteristic manifestations of FNH,but it is not essential.The histological features of FNH are the response of bile duct hyperplasia,angiogenesis and the absence of abnormal cells.4.The map-like expression of GS on FNH suggested a close relationship with central scar.The typical central scar formation may be related to collagen fibers.The proportion of collagen fibers≥20%may be the critical value of central scar formation.5.The prognosis of FNH is good after resection.The incidence of FNH is not directly related to oral administration of progesterone,but may be related to the level of progesterone.