Focal nodular hyperplasia - Revision history

Mitchell: /* Images */ added a case of FNH with stains

2016-07-11T21:05:53Z

Images: added a case of FNH with stains

← Older revision		Revision as of 21:05, 11 July 2016
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	www:		www:
	*[http://path.upmc.edu/cases/case444.html FNH - several images (upmc.edu)].		*[http://path.upmc.edu/cases/case444.html FNH - several images (upmc.edu)].

			{\|
			[[File:1 FNH 1 680x512px.tif\|Trichrome shows fibrous scar with vessels/bile ductules (40X)]]
			[[File:2 FNH 1 680x512px.tif\|PAS-D shows tortuous bile ductules at edge of scar with minimal inflammation (200X)]]
			[[File:3 FNH 1 680x512px.tif\|PAS-D shows proliferated blood vessels in center of scar with minimal inflammation (200X).]]
			[[File:4 FNH 1 680x512px.tif\|Reticulin shows regeneration [two nuclei thick cords between black lines] (400X)]]
			\|}
			Focal nodular hyperplasia. Trichrome shows fibrous scar with vessels/bile ductules (UL 40X). PAS-D shows tortuous bile ductules at edge of scar with minimal inflammation (UR 200X).
			PAS-D shows proliferated blood vessels in center of scar with minimal inflammation (LL 200X). Reticulin shows regeneration [two nuclei thick cords between black lines] (LR 400X).

	==See also==		==See also==

Michael: +infobox

2014-09-17T04:45:55Z

+infobox

← Older revision		Revision as of 04:45, 17 September 2014
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			{{ Infobox diagnosis
			\| Name = {{PAGENAME}}
			\| Image = Focal_nodular_hyperplasia_-_intermed_mag.jpg
			\| Width =
			\| Caption = Focal nodular hyperplasia. [[H&E stain]].
			\| Synonyms =
			\| Micro = thick walled blood vessels without bile ducts of same size, bile ductular proliferation at the edge of the fibrosis tissue
			\| Subtypes =
			\| LMDDx = [[hepatic adenoma]], [[cirrhosis]]
			\| Stains =
			\| IHC =
			\| EM =
			\| Molecular =
			\| IF =
			\| Gross = well circumscribed with capsule, lighter than surrounding parenchyma - may be yellow, +/-stellate central scar with thick vessels
			\| Grossing =
			\| Site = [[liver]] - see ''[[medical liver disease]]''
			\| Assdx =
			\| Syndromes = [[hereditary hemorrhagic telangiectasia]]
			\| Clinicalhx =
			\| Signs =
			\| Symptoms =
			\| Prevalence =
			\| Bloodwork =
			\| Rads = usu. solitary lesion, arterial phase enhancement in triphasic imaging
			\| Endoscopy =
			\| Prognosis = benign
			\| Other =
			\| ClinDDx =
			\| Tx =
			}}
	'''Focal nodular hyperplasia''', abbreviated '''FNH''', is a benign [[liver]] lesion, uncommonly seen by pathologists.		'''Focal nodular hyperplasia''', abbreviated '''FNH''', is a benign [[liver]] lesion, uncommonly seen by pathologists.

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	*Lighter than surrounding parenchyma, may be yellow.		*Lighter than surrounding parenchyma, may be yellow.
	*+/-Stellate central scar with thick vessels.		*+/-Stellate central scar with thick vessels.
	**Can be identified on ~~medial~~ imaging.		**Can be identified on medical imaging.

	Note: Usually a solitary lesion.<ref name=emedicine_fnh/>		Note: Usually a solitary lesion.<ref name=emedicine_fnh/>

Michael: split out

2014-09-17T04:38:15Z

split out

← Older revision		Revision as of 04:38, 17 September 2014
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	#~~redirect~~ [[~~Medical_liver_disease#Focal_nodular_hyperplasia~~]]		'''Focal nodular hyperplasia''', abbreviated '''FNH''', is a benign [[liver]] lesion, uncommonly seen by pathologists.

			==General==
			*Not commonly seen by pathologists, as these are usually distinctive on medical imaging.<ref name=pmid11274535>{{Cite journal \| last1 = Brancatelli \| first1 = G. \| last2 = Federle \| first2 = MP. \| last3 = Grazioli \| first3 = L. \| last4 = Blachar \| first4 = A. \| last5 = Peterson \| first5 = MS. \| last6 = Thaete \| first6 = L. \| title = Focal nodular hyperplasia: CT findings with emphasis on multiphasic helical CT in 78 patients. \| journal = Radiology \| volume = 219 \| issue = 1 \| pages = 61-8 \| month = Apr \| year = 2001 \| doi = \| PMID = 11274535 }}</ref>
			*Benign lesions.
			*May be seen in the context of [[hereditary hemorrhagic telangiectasia]].<ref name=pmid18814078>{{cite journal \|author=Khalid SK, Garcia-Tsao G \|title=Hepatic vascular malformations in hereditary hemorrhagic telangiectasia \|journal=Semin. Liver Dis. \|volume=28 \|issue=3 \|pages=247–58 \|year=2008 \|month=August \|pmid=18814078 \|doi=10.1055/s-0028-1085093 \|url=}}</ref>

			Note:
			*Oral contraceptive pill (OCP) use does '''not''' appear to be a factor in the growth of these lesions;<ref name=pmid19751862>{{Cite journal \| last1 = Kapp \| first1 = N. \| last2 = Curtis \| first2 = KM. \| title = Hormonal contraceptive use among women with liver tumors: a systematic review. \| journal = Contraception \| volume = 80 \| issue = 4 \| pages = 387-90 \| month = Oct \| year = 2009 \| doi = 10.1016/j.contraception.2009.01.021 \| PMID = 19751862 }}</ref> however, the study claims there is nothing on [[hepatocellular adenoma]]s -- yet I found a ''JAMA'' paper by Rooks ''et al.''<ref name=pmid221698>{{Cite journal \| last1 = Rooks \| first1 = JB. \| last2 = Ory \| first2 = HW. \| last3 = Ishak \| first3 = KG. \| last4 = Strauss \| first4 = LT. \| last5 = Greenspan \| first5 = JR. \| last6 = Hill \| first6 = AP. \| last7 = Tyler \| first7 = CW. \| title = Epidemiology of hepatocellular adenoma. The role of oral contraceptive use. \| journal = JAMA \| volume = 242 \| issue = 7 \| pages = 644-8 \| month = Aug \| year = 1979 \| doi = \| PMID = 221698 }}</ref> on this topic.

			===Imaging===
			*FNH enhances on the arterial phase in triphasic imaging, i.e. triphasic CT or MRI.<ref name=emedicine_fnh>[http://emedicine.medscape.com/article/368377-overview http://emedicine.medscape.com/article/368377-overview]</ref><ref name=pmid11274535>{{Cite journal \| last1 = Brancatelli \| first1 = G. \| last2 = Federle \| first2 = MP. \| last3 = Grazioli \| first3 = L. \| last4 = Blachar \| first4 = A. \| last5 = Peterson \| first5 = MS. \| last6 = Thaete \| first6 = L. \| title = Focal nodular hyperplasia: CT findings with emphasis on multiphasic helical CT in 78 patients. \| journal = Radiology \| volume = 219 \| issue = 1 \| pages = 61-8 \| month = Apr \| year = 2001 \| doi = \| PMID = 11274535 }}</ref>

			==Gross==
			Features:<ref name=Ref_PBoD922>{{Ref PBoD\|922}}</ref>
			*Well circumscribed, but no capsule.
			*Lighter than surrounding parenchyma, may be yellow.
			*+/-Stellate central scar with thick vessels.
			**Can be identified on medial imaging.

			Note: Usually a solitary lesion.<ref name=emedicine_fnh/>

			==Microscopic==
			Features:<ref name=Ref_PBoD922>{{Ref PBoD\|922}}</ref>
			*Classically a stellate scar that has large arteries with fibromuscular hyperplasia.
			**Thin fibrous septa radiate from the central scar - surrounded by lymphocytes & bile ductules.
			***Normal hepatocytes between fibrous septae.

			Practical features:
			#Thick walled blood vessels.
			#*Bile duct of same size not seen.
			#Bile ductular proliferation at the edge of the fibrosis tissue.
			#Clinical history: it is a focal lesion.

			DDx:
			*[[Hepatic adenoma]] - may be difficult to distinguish, if no scar and no ductal proliferation.<ref>STC. 19 Jan 2009.</ref>
			*[[Cirrhosis]] - complete nodules
			**FNH has incomplete nodules.

			Memory device ''FNH'' = '''f'''ocal lesion, '''n'''umerous bile ductules, '''h'''yperplasia of arteries.

			===Images===
			<gallery>
			Image:Focal_nodular_hyperplasia_-_low_mag.jpg \| FNH - looks a bit like cirrhosis - low mag. (WC)
			Image:Focal_nodular_hyperplasia_-_intermed_mag.jpg \| FNH - intermed. mag. (WC)
			Image:Focal_nodular_hyperplasia_-_high_mag.jpg \| FNH - high mag. (WC)
			</gallery>
			www:
			*[http://path.upmc.edu/cases/case444.html FNH - several images (upmc.edu)].

			==See also==
			*[[Medical liver disease]].

			==References==
			{{Reflist\|2}}

	[[Category:Diagnosis]]		[[Category:Diagnosis]]
			[[Category:Medical liver disease]]

Michael: +cat.

2011-10-26T04:40:55Z

+cat.

← Older revision		Revision as of 04:40, 26 October 2011
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	#redirect [[Medical_liver_disease#Focal_nodular_hyperplasia]]		#redirect [[Medical_liver_disease#Focal_nodular_hyperplasia]]

			[[Category:Diagnosis]]

Michael: redirect

2011-09-22T14:18:07Z

redirect

New page

#redirect [[Medical_liver_disease#Focal_nodular_hyperplasia]]