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Joseph Junewick, MD FACR
over 7 years ago
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Focal Nodular Hyperplasia

Case Detail

Anatomy: Gastrointestinal
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Neoplasia Benign
Created: over 4 years ago
Updated: over 4 years ago
Tags: PEDS
Modality/Study Types: US MR
Activities:
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History

17 year old female with vague abdominal symptoms.


Case Images


Diagnosis

Focal Nodular Hyperplasia

Findings

US – Round isoechoic region of subtly disordered echogenicity in the right lobe of the liver with large central vessel on color Doppler.

MR – Slightly hyperintense macrolobulated mass in the right lobe of the liver with marker early enhancement, equilibration on portal venous phase, and central vascular pooling on delayed imaging.

Discussion

Focal nodular hyperplasia is a rare tumor-like condition which may occur in both sexes and all age groups although predominantly found in women during the third to fifth decade of life. In childhood, focal nodular hyperplasia represents only 2% of hepatic tumors. Most commonly, it is incidentally discovered in asymptomatic patients. The cause of focal nodular hyperplasia is not well understood but may be related to congenital vascular malformation or vascular injury; estrogens may play a role in the growth of these lesions.

Generally, focal nodular hyperplasia presents as a solitary nodule smaller than 5 cm in diameter. The mass is usually lobulated and well circumscribed, although unencapsulated. The pathognomonic macroscopic feature is the presence of a central arterial supply with adjacent fibrosis and radiating stellate scar; internal necrosis and hemorrhage are extremely rare. The nodules seen in focal nodular hyperplasia lack normal central veins and portal tracts. The bile ductules seen in the central scar do not connect to the biliary tree.

Typical MR features of focal nodular hyperplasia are iso- or hypointensity on T1-weighted images; slight hyper- or isointensity on T2-weighted images; homogeneity; and the presence of a central scar that appears hyperintense on T2-weighted images because of its vascular channels, bile ductules, and increased edema in the myxomatous tissue. After administration of contrast, there is dramatic enhancement in the arterial phase, followed by isointensity of the lesion during the portal venous phase. On delayed phase imaging, the central scar shows high signal intensity because of the accumulation of contrast material.

Reference

Mortele KJ, Praet M, Van Vlierberghe H, et al. CT and MR Imaging Findings in Focal Nodular Hyperplasia of the Liver:
Radiologic—Pathologic Correlation. AJR (2000); 175(3):687-692.

Reymond D, Plaschkes J, Luthy AR, et al. Focal nodular hyperplasia of the liver in children: review of follow-up and outcome. J Pediatr Surg (1995);30:1590 -1593.



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