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Focalnodularhyperplasia(FNH)
Outline
FNHaccountsforapproximately8%ofallprimaryhepatictumorandisthesecondmostcommonbenignlivertumorafterhemangioma.
Thisbenigntumouroccursmostcommonlyinwomenaged20–50years,butmayoccurinbothmenandwomenatanyage,withmultiplelesionsbeingfoundin20percentofcases.FNH
Oralcontraceptive口服避孕药useisassociatedwithFNHbuttheresponsibilityoforalcontraceptivesintheoccurrenceofthelesionhasnotbeendemonstrated.
well-circumscribedlobulatedmasswithcentralscar(arrow)andradiatingseptations.
PathologicalappearanceFNHisdefinedasanodulecomposedofbenign-appearinghepatocytesoccurringinaliverthatisotherwisehistologicallynormal.FNHisahyperplasticliverparenchyma（增生性肝实质）subdividedintonodulesbyfibrousseptathatmayformstellatescars（星状瘢痕）.Thelesionisusuallysolitary(80%)andmeasureslessthan5cmindiameter.Occasionally,FNHispedunculated(蒂).Photomicrographofhistopathologicspecimenshowsregionsofnodularhepatocellularproliferationseparatedbyradiatingbandsandsurroundingmyxomatousscar(arrows).FNHclassic(80%)non-classic(20%)
(a)telangiectaticFNH,
(b)withatypia,
(c)mixedhyperplasticandadenomatousFNH
Diagnosis（CT）NonenhancedCTscansFNHisdemonstratedasafocalhypodenseorisodensemasscomparedwithnormalliver.Acentralhypodensescarisdepictedinonlyone-thirdofthecases.Calcificationswithinthecentralscarareveryrareandobservedinonlyabout1%ofthecases.contrast-enhancedCTscanarterial
phaseThelesionenhancesrapidlyinmostcasesandthelesiontolivercontrastishigh.Lesioncontouriswelldemarcatedandmaybelobulated.Atthattime,thecentralscarishypodenseandappearsmoreevidentthanonunenhancedCTscans.
delayed
phase
FNHareisodenserelativetonormalliverandinmostcases,centralscarsappearisoorhyperattenuating.Acentralscarisobservedmoreofteninlargelesionsthaninsmalllesions.CTT1WIT2WI
Diagnosis（MRI）NonenhancedMRIscans
TypicalFNHsareisoorhypointenseonT1WIandisoorslightlyhyperintenseonT2WI.
ThecentralscarishypointenseonT1WI
andstronglyhyperintenseonT2WI.Atypicalformsscarsareseeninmorethan80%ofcases.However,radio-pathologicpapershavedemonstratedthatsomeFNHmayhavenoscarevenatpathologyespeciallyFNHmeasuringlessthan3cmindiameter。
Rarely,scarsremainhypodenseorisodenseondelayedscansorarehypointenseonT2-weightedimages.Thesefindingsmaybeobservedupto20%ofcases.
NearlyallFNHsarehypervascularatthearterialphaseoftheenhancement,butlesionenhancementmayvaryattheportalphaseorondelayedimages.Bothhypodensityorintensityofthemassondelayedphase,oronbothportalveinanddelayedphaseimagesaswellashyperdensity-intensityofthemassontheportalveinphaseoronbothportalveinanddelayedphasesmaybeseen.
Differentialdiagnosis肝囊肿Hepaticcyst
原发性肝癌primaryhepaticcarcinoma肝囊肿Hepaticcystnoncontrast-enhancedcontrast-en
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