From the Guidelines
The correct answer is (a) hepatic focal nodular hyperplasia usually occurs in women of reproductive age. This benign liver lesion is the second most common benign liver tumor and predominantly affects women between 20-50 years of age, with a female-to-male ratio of approximately 8:1 1. While there was historically thought to be an association with oral contraceptive use (option b), current evidence does not support a causal relationship, though hormones may influence its growth 1. Most cases of focal nodular hyperplasia are asymptomatic and discovered incidentally during imaging for other reasons, making option (c) incorrect as abdominal pain is not a typical presentation for most patients. Regarding option (d), focal nodular hyperplasia has an extremely low risk of complications such as spontaneous rupture or hemorrhage, unlike hepatic adenomas which do carry such risks 1. The lesion is characterized by a central stellate scar with radiating fibrous septa containing malformed vessels, and typically does not require treatment unless symptomatic. Some key points to consider include:
- Focal nodular hyperplasia (FNH) is a benign liver lesion that is commonly diagnosed in reproductive-aged women 1.
- The association of FNH with estrogen is not well established, and current evidence does not support a causal relationship between FNH and oral contraceptive use 1.
- Pregnancy is not contraindicated in women with FNH, and vaginal delivery is not associated with increased risks 1.
- Imaging is not routinely recommended to monitor FNH during pregnancy, unless there are symptoms or other indications 1.
From the Research
Hepatic Focal Nodular Hyperplasia Characteristics
- Hepatic focal nodular hyperplasia (FNH) usually occurs in women of reproductive age 2, 3
- FNH is not directly related to oral contraceptive use, although some studies suggest a possible influence of female hormones on the course of FNH 4, 2, 3
- FNH often presents without symptoms, and abdominal pain is not a typical presentation in most cases 4, 3, 5
- There is no significant evidence to suggest that FNH carries a substantial risk of spontaneous rupture 4, 3, 5
Relationship with Oral Contraceptives
- Discontinuation of oral contraceptives may reduce the size of FNH, as observed in some cases 2
- However, the relationship between oral contraceptive use and FNH is not as clear-cut as it is with hepatic adenoma 3
Diagnosis and Treatment
- Diagnostic certainty and symptomatic assessment are key issues in surgical decision-making for FNH 5
- Patients with asymptomatic definitive FNH can be safely managed conservatively 5
- Surgical resection is a safe and effective treatment for symptomatic patients, but evidence of symptom resolution is also reported with conservative strategies 5, 6