Diese Präsentation wurde erfolgreich gemeldet.
Wir verwenden Ihre LinkedIn Profilangaben und Informationen zu Ihren Aktivitäten, um Anzeigen zu personalisieren und Ihnen relevantere Inhalte anzuzeigen. Sie können Ihre Anzeigeneinstellungen jederzeit ändern.

Nodular hyperplasia of the liver

1.634 Aufrufe

Veröffentlicht am

Focal Nodular Hyperplasia of the liver: DD. and management with a scope on ACG 2014 guidelines

Veröffentlicht in: Gesundheit & Medizin
  • Discover A Simple Holistic System For Curing Acne Once And For All using 100% Guaranteed All-Natural Method. Click Here ■■■ http://t.cn/AiWGkfA8
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier
  • STOP GETTING RIPPED OFF! LEARN THE SHOCKING TRUTH ABOUT ACNE, DRUGS, CREAMS AND THE ONLY PATH TO LASTING ACNE FREEDOM... To get the FACTS on exactly how to eliminate your Acne from the root 100% naturally and Permanently and achieve LASTING clear skin without spending your hard-earned money on drugs and over the counters... ◆◆◆ http://t.cn/AiWGkfAm
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier
  • Is it possible to lose belly fat in a week? ●●● https://tinyurl.com/bkfitness4u
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier

Nodular hyperplasia of the liver

  1. 1. Nodular Hyperplasia of the Liver By Dr. Ihab Samy Surgical Oncology Dept. National Cancer Institute-Cairo Unversity 2014
  2. 2.  Benign liver cell tumors (BLCT) are common and their clinical management remains controversial.  The differential diagnosis of liver tumors requires understanding of the clinical and imaging features of the liver lesions.
  3. 3. FOCAL NODULAR HYPERPLASIA  This is the second most prevalent benign liver lesion (after hemangioma), with a woman preponderance, in 80–90% of the cases, in third or fourth decade and a global incidence of about 0.6–3% of the general population.  There is no identifiable etiologic factor. It is, however, associated with a condition having local or systemic vascular anomalies.  The most accepted theory posits a congenital vascular malformation as the trigger event; however, it is thought to arise as a result of larger-than-expected pre-existing spider-like arterial structures with heterogeneous blood flow in the liver cellular architecture, resulting a hyperplastic hepatocytic response
  4. 4.  FNH is a benign idiopathic fleshy tumour of the liver, ten times more common than adenoma and is found at any age but mainly in adults.  Most of the patients are not symptomatic and the diagnosis is made incidentally during surgery, autopsy or imaging procedures for others symptoms.  The liver function tests are normal.  Complications, as the rupture, bleeding or malignant transformation, although rare, are described in literature
  5. 5.  Tumour is more or less rounded, lobulated and well demarcated but not encapsulated with a diameter ranging from one to several centimetres.  When the tumour is large, it may be painful.  Other symptoms described are loss of appetite, nausea, vomiting and weight loss.
  6. 6.  Usually occurs in non-cirrhotic livers.  A central fibrous scar with prominent arterial branches is typically observed at the histological examination.  Some cases reported of FNH complications mention dilatation of intrahepatic bile duct, compression of portal vein, compression of stomach, compression of inferior vena cava, intra-tumor bleeding and intra-peritoneal rupture.
  7. 7. Diagnosis: Imaging  The diagnosis of FNH can be made using imaging techniques in 90% of cases in experienced centers.  The characteristic radiologic findings of FNH have been well documented, but the exact distinction of FNH from other hypervascular hepatic tumors is not easy, especially in cases of small lesions.
  8. 8.  Contrast-enhanced ultrasonography (CEUS) is the first modality of choice for FNH:FNH typically shows arterial increase enhancement, very marked in the first few seconds.  Centrifugal (70%) or eccentric (30%) enhancement through one afferent correspondingly situated arteries is a diagnostic pointer.  Recently in 2013, Wang et al. from the University of Guangzhou (Republic of China) confirmed that the contrast-enhanced computed tomography (CECT) have similar diagnostic performance for FNH and CEUS should be the first imaging technique for the diagnosis of FNH.
  9. 9.  Gadoxetic acid (Gd-EOB-DTPA, Primovist®, Bayer Schering Pharma AG, Berlin, Germany) is a hepatocyte-specific magnetic resonance (MR) contrast agent that is increasingly used for liver MR imaging.  Gadoxetic acid is actively taken up by hepatocytes and excreted along the bile duct and kidney.  It is known to be specific for the diagnosis of FNH, showing hyperintense or isointense regions compared to the liver during the delayed hepatobiliary phase
  10. 10.  On dynamic contrast-enhanced MR images, FNH usually shows homogeneous enhancement during the arterial phase, compartmentalized by radiate fibrous septae, arising from the nonenhancing central scar.  The central scar of FNH usually shows a high SI on T2WI and delayed enhancement because it is mainly a vascular and inflammatory scar.
  11. 11. CT with contrast
  12. 12. Management and Treatment of FNH  If the patient is female with typical FNH on imaging, normal liver tests and no medical history of cancer, the diagnosis of FNH is considered and the biopsy is not necessary.  If the patient is a male, biopsy is proposed. In the case of atypical FNH on imaging biopsy is necessary.  FNH is often asymptomatic and the surgery is not indicated even if the lesion is large.
  13. 13.  However, the patients with a large lesions can to develop abdominal pain or compression of adjacent structures and liver resection may be indicated.  Cherqui D,2008 published a short report on clinical management of benign liver cell tumors and it is proposed for FNH monitoring by an MRI six and twelve months, then MRI or CEUS each year for three years after then stop monitoring.
  14. 14. ACG Clinical Guideline 2014 for FNH  An MRI or CT scan should be obtained to confirm a diagnosis of FNH. A liver biopsy is not routinely indicated to confirm the diagnosis (strong recommendation, low quality of evidence).  Pregnancy and the use of oral contraceptives or anabolic steroids are not contraindicated in patients with FNH (conditional recommendation, low quality of evidence).  Asymptomatic FNH does not require intervention (strong recommendation, moderate quality of evidence).  Annual US for 2 – 3 years is prudent in women diagnosed with FNH who wish to continue OCP use. Individuals with a firm diagnosis of FNH who are not using OCP do not require follow-up imaging (conditional recommendation, low quality of evidence).
  15. 15. Thank you

×