Focal nodular hyperplasia of the liver in longterm survivors of neuroblastoma: how much diagnostic imaging is necessary?
OBJECTIVE
Focal nodular hyperplasia of the liver is a tumor-like lesion, uncommon in children, but it has recently been more frequently observed in children treated for malignant diseases, especially neuroblastoma. The aetiology is unclear, the pathogenesis remains controversial. Focal nodular hyperplasia of the liver is suspected to be a sequela of tumor therapy.


METHODS
Besides the clinical data we evaluated the imaging modalities needed to diagnose focal nodular hyperplasia of the liver in children with neuroblastoma who have been followed in our institution for more than 5 years.


RESULTS
Out of 60 children six developed focal nodular hyperplasia at a median time of 10.5 years after diagnosis of neuroblastoma and 9.4 years after the end of treatment. The diagnosis of focal nodular hyperplasia was based on imaging criteria which are variable in ultrasonography and specific in MRI. Only one child underwent surgical biopsies to rule out liver metastases.


CONCLUSIONS
Longterm survivors of neuroblastoma are at risk of developing focal nodular hyperplasia, especially if they underwent toxic chemotherapy and/or radiotherapy to the liver during initial treatment. The recommended diagnostic imaging tools are ultrasonography for detecting liver lesions and MRI for confirming and characterizing these lesions as focal nodular hyperplasia.
Division of Pediatric Radiology, A. Gossmann (formerly), Department of Radiology, University of Cologne, Kerpenerstr. 62, 50924 Köln, Germany. g.benz-bohm@t-online.de
Gabriele
G
Benz-Bohm
Barbara
B
Hero
Axel
A
Gossmann
Thorsten
T
Simon
Friederike
F
Körber
Frank
F
Berthold
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000175:diagnosis* / Q000401:mortality*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D009447:Neuroblastoma / Q000175:diagnosis* / Q000401:mortality*; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D017741:Survivors / Q000706:statistics & numerical data*; D014463:Ultrasonography / Q000706:statistics & numerical data*; D055815:Young Adult