Invited commentary: Focal nodular hyperplasia of the liver — A single institution experience


This series of focal nodular hyperplasia (FNH) is certainly a very important one. The authors (4) described clinical signs and imaging characteristics of 39 patients. The diagnostic steps were clearly presented emphasizing the value of scintigraphy. Yet, we encountered the stellate scar characteristic of FNH in CTscans or magnetic resonance of only 19% of our cases (I). Fine needle aspiration and percutaneous liver biopsy should be discussed mainly for use in superficial lesions because the method does not only carry the risk of bleeding but also of seeding neoplastic cells in case of hepatocellular carcinoma (HCC). Moreover, biopsy will yield only normal hepatocytes even in FNH if the the central scar is missed. As far as surgical therapy is concerned, the main indication of surgery is the misdiagnosis of FNH. If there was any doubt of adenoma or HCC, a liver resection should be undertaken. Surgery is also indicated for the symptomatic forms or in the case of diagnosis before pregnancy. Yet, two of our patients suffered from recurrent pain after surgery. For that reason, we recommend careful assessment betbre considering resection in patients (1). In all other situations, in which the diagnosis of focal nodular hyperplasia can be established with certainty by non-surgical methods, conservative management is the treatment of choice (1). Whichever mechanisms axe responsible t'or the development of FNH, there is strong evidence for estrogens to stimulate the growth of FNH (2). 82% of women in our series were of childbearing age, and 64% had a history of oestrogen use for 3 to 13 years. Furthermore, women who used oral contraceptives had significantly larger lesions than those who did not (p = 0.004). A comprehensive review of French surgeons in 351 FNH patients showed that those who were under oral contraceptives were more likely to be symptomatic, or to experience tumor rupture or bleeding than those who did not take oral contraceptives (2). An increase in nuclear oestrogen receptors in FNH cells may be a possible explanation (3). Oestrogen use should be discontinued and patients warned of the possible risks that pregnancy entails.

DOI: 10.1007/BF02619977

Cite this paper

@article{Launois2007InvitedCF, title={Invited commentary: Focal nodular hyperplasia of the liver — A single institution experience}, author={Prof. B. Launois}, journal={Acta Chirurgica Austriaca}, year={2007}, volume={26}, pages={113-113} }