title: Co-existence of hepatocellular adenoma and focal nodular hyperplasia in a young female.
abstract: Focal nodular hyperplasia (FNH) and hepatocellular adenoma (HA) are both benign hepatocellular lesions, presenting mainly in women of childbearing age in non-cirrhotic, non-fibrotic livers. Simultaneous occurrence of these two lesions is extremely rare. We herein report a case of a young female without any predisposing risk factors who presented to our emergency department complaining of acute abdominal pain. Imaging studies revealed a 6 cm lesion in the right hepatic lobe and a 2.5 cm lesion in the left hepatic lobe, respectively. In view of the patient's symptoms and lack of a confirmed diagnosis based on imaging, we performed a bisegmentectomy V-VI and a wedge resection of the lesion in segment III by laparotomy. Postoperative course was uneventful and the patient was discharged on the fourth postoperative day. The pathology report demonstrated an HA in segments V-VI and FNH in segment III, respectively. Six months later, the patient remains asymptomatic with normal liver function tests, ultrasound and magnetic resonance imaging follow-up. To our best knowledge, this is the first case to describe simultaneous occurrence of HA and FNH without the presence of any known risk factors for these entities. The uncertainty in diagnosis and acuteness of presenting symptoms were established criteria for prompt surgical intervention.
authors.affiliation: Dimitrios Dimitroulis, Panagiotis Lainas, Petros Charalampoudis, Theodore Karatzas, Nikolaos Karidis, Gregory Kouraklis, 2nd Department of General Surgery, Laiko Hospital, University of Athens Medical School, 11527 Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Dimitroulis
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Lainas
authors.forename: Petros
authors.initials: P
authors.lastname: Charalampoudis
authors.forename: Theodore
authors.initials: T
authors.lastname: Karatzas
authors.forename: Ioanna
authors.initials: I
authors.lastname: Delladetsima
authors.forename: Stratigoula
authors.initials: S
authors.lastname: Sakellariou
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Karidis
authors.forename: Gregory
authors.initials: G
authors.lastname: Kouraklis
keywords: Benign hepatic tumor; Focal nodular hyperplasia; Hepatocellular adenoma; Liver disease; Liver surgery