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 for unrelated conditions. Only about 20% of patients present with abdominal pain (option c is incorrect). FNH has a characteristic central stellate scar with radiating fibrous septa and is considered a stable lesion with minimal risk of complications. Unlike hepatic adenomas, FNH rarely undergoes spontaneous rupture or hemorrhage (option d is incorrect), making it a lesion that generally requires no intervention unless symptomatic, as supported by a study published in Hepatology in 2021 1. The benign nature of FNH and its low complication rate typically allows for conservative management with periodic imaging surveillance rather than surgical resection.
Some key points to consider in the management of FNH include:
- The association of FNH with estrogen is not well established, and pregnancy is not contraindicated in women with FNH, as stated in the EASL clinical practice guidelines on the management of liver diseases in pregnancy 1.
- Imaging is not routinely recommended to monitor FNH during pregnancy, unless there are specific concerns or symptoms, as recommended in the guidelines 1.
- The risk of spontaneous rupture or hemorrhage is extremely low, and FNH is generally considered a stable lesion, as reported in the literature 1.
Overall, the management of FNH should prioritize a conservative approach, with periodic imaging surveillance and monitoring for symptoms, rather than surgical intervention, in order to minimize morbidity, mortality, and optimize quality of life.
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, 4.
- There is a suggested relationship between FNH and oral contraceptive use, with some studies indicating that discontinuation of oral contraceptives can reduce the size of FNH 2, 5.
- FNH is often asymptomatic, with complications being extremely rare, and surgical resection is generally not advised unless in symptomatic patients or those with diagnostic uncertainty 3, 4, 6.
- The risk of spontaneous rupture is not commonly associated with FNH, but rather with hepatic adenoma, a different type of liver tumor 3.
Clinical Presentation and Management
- Abdominal pain is not typically the primary presenting symptom of FNH, as most cases are asymptomatic 3, 4.
- The management of FNH usually involves systematic follow-up, with elective surgery considered in symptomatic patients or those with marked enlargement and uncertainty of diagnosis 4, 6.
- Diagnostic modalities such as ultrasound, computed tomography, and magnetic resonance imaging are used to confirm the presence of FNH, with percutaneous biopsy generally avoided due to the risk of tumor seeding 6.