Management and algorithm for focal nodular hyperplasia of the liver in children.
OBJECTIVE
The aim of this study was to determine an appropriate management plan for childhood and adolescent FNH, in particular to establish an algorithm for preoperative diagnosis and treatment.


METHODS
Between 1985 and 2003, 4 children with FNH were diagnosed. Of these 4 patients, 3 (Group A) underwent tumor resection, and 1 (Group B) was treated by conservative management. Clinical data, pathological findings and follow-up were evaluated retrospectively.


RESULTS
The 3 patients in Group A were symptomatic, while the 1 patient in Group B was asymptomatic. In 3 of 4 patients, a homogeneous tumor with a central stellate area was noted on abdominal ultrasonography, CT scan and MR imaging. In case 2, SPIO-enhanced MR imaging was useful for differentiating FNH from hepatocellular carcinoma. Though percutaneous needle biopsy was performed in case 3, a pathologically definitive diagnosis was impossible. An open biopsy was performed in case 4 and FNH was diagnosed. In case 4 treated by conservative management, the tumor size did not change during the 7 years after the diagnosis of FNH.


CONCLUSIONS
FNH is usually treated conservatively because of the good evolutionary outcome of the lesion. Surgery is indicated in cases of complications, compressed adjacent organs, lesion progression, or for symptomatic patients. We advocate the use of less invasive SPIO-enhanced MR imaging instead of open biopsy when the diagnosis of focal liver lesions is not clear after contrast-enhanced CT scan and non-enhanced MR imaging.
Okada
T
T
Department of Pediatric Surgery, First Surgery, Radiology, Hokkaido University Graduate School of Medicine, and Hokkaido University Hospital, Pathology, Sapporo, Japan. okadata@med.hokudai.ac.jp
Sasaki
F
F
Kamiyama
T
T
Nakagawa
T
T
Nakanishi
K
K
Onodera
Y
Y
Itoh
T
T
Todo
S
S
D000293:Adolescent; D001707:Biopsy, Needle; D002648:Child; D020518:Focal Nodular Hyperplasia / Q000175:diagnosis / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed