From the Guidelines
The correct answer is (a) usually occurs in women of reproductive age. Hepatic focal nodular hyperplasia (FNH) is a benign liver lesion that predominantly affects women between the ages of 20-50 years, with a female-to-male ratio of approximately 8:1, as reported in a study published in the Journal of Hepatology in 2023 1. Despite common misconception, FNH is not causally related to oral contraceptive use (option b is incorrect), although hormones may influence its growth in some cases. Most patients with FNH are asymptomatic, with the lesion often discovered incidentally during imaging performed for unrelated reasons. Only about 20% of patients present with abdominal pain (option c is incorrect). FNH has a very low risk of complications, and spontaneous rupture is extremely rare (option d is incorrect), with only one case of hepatic rupture reported in the literature 1. The lesion is characterized pathologically by a central stellate scar with radiating fibrous septa containing malformed vessels, surrounded by nodules of hyperplastic hepatocytes. Management is typically conservative with observation, as these lesions have no malignant potential and rarely cause clinical problems. According to the EASL clinical practice guidelines on the management of liver diseases in pregnancy, women with FNH should be advised that pregnancy is not contraindicated and vaginal delivery is not associated with increased risks 1.
Some key points to consider in the management of FNH include:
- FNH is a benign liver lesion with a low risk of complications
- Pregnancy is not contraindicated in women with FNH
- Vaginal delivery is not associated with increased risks in women with FNH
- Imaging is not routinely recommended to monitor FNH during pregnancy, unless there are specific concerns or symptoms 1
- The relationship between FNH and estrogen exposure is controversial, but most studies suggest that hormones may influence the growth of FNH in some cases 1.
Overall, the management of FNH should be individualized and based on the specific needs and circumstances of each patient, with a focus on minimizing risks and optimizing outcomes.
From the Research
Hepatic Focal Nodular Hyperplasia Characteristics
- Hepatic focal nodular hyperplasia (FNH) usually occurs in women of reproductive age, as stated in studies 2, 3.
- There is evidence to suggest a relationship between FNH and oral contraceptive use, with some studies indicating that discontinuation of oral contraceptives can reduce the size of FNH 2, 4, 5.
- FNH is not typically associated with abdominal pain, and most patients are asymptomatic 6, 3.
- The risk of spontaneous rupture is extremely rare, but it has been reported in some cases, particularly with large FNH lesions 6.
Clinical Presentation and Management
- FNH is often found incidentally, and patients are rarely symptomatic 3.
- When symptoms do occur, they may include epigastric or right upper quadrant pain 3.
- Imaging techniques, such as magnetic resonance (MR) imaging, Doppler ultrasonography (US), and contrast-enhanced US (CEUS), can be used to diagnose FNH and differentiate it from other hypervascular hepatic lesions 3.
- In most cases, there is no indication for surgery, and treatment includes conservative clinical follow-up in asymptomatic patients 3.