Focal Nodular Hyperplasia

Introduction

Focal nodular hyperplasia is a benign liver lesion which is usually solitary and presents mostly as an incidental finding
Its treated conservatively as prognosis is excellent
It presents between the ages of 35 to 50
It is the second most common liver lesion that’s not malignant
90% of cases occur in women

Blood tests are usually normal, including LFTs and Alpha-fetoprotein.

Notably, accurate imaging, can help with diagnosis to prevent unnecessary intervention. Key options include contrast-enhanced ultrasound, a multiphase liver CT, and an MRI.

A biopsy of the lesion is not routinely indicated to confirm the diagnosis. However, it may be necessary if the contrast-enhanced imaging features are not typical of FNH.

Differentials to rule out:

Hepatocellular adenoma
Hepatocellular carcinoma
Fibrolamellar carcinoma

As the prognosis is excellent, with complications being very rare, minimal intervention is advised. Surveillance imaging is not routinely obtained as there is a low risk of lesion growth.

However, symptomatic lesions that induce persistent abdominal pain may require procedural intervention. One option is surgical resection, although this can be quite invasion. Consequentially, approaches including transarterial embolization or radiofrequency ablation are preferred.

Everything you need to know about FNH can be remember with this acronym.

FOCAL stands for:

Females patients who have an
Oval lesion with a
Central scar which is
Asymptomatic their
Liver.