Estrogen-Driven Growth of Focal Nodular Hyperplasia: Truth or Myth?

Ashhab, Ashraf A.; Abu-Sulb, Ahmad; Yang, Ju Dong; Noureddin, Mazen; Sundaram, Vinay; Kuo, Alexander; Ayoub, Walid

doi:10.14309/crj.0000000000000531

Cited by 6 publications

(7 citation statements)

References 17 publications

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“…Kim and Ashbab reported that while FNH remains stable during pregnancy, tumor growth can still be detected in some patients, which increases the di culty of surgery and the risk of pregnancy [3,23,24]. This will increase the psychological burden of pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Focal nodular hyperplasia: are the existing surgical indications sufficient?

Zhang

Qin

et al. 2022

Preprint

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Background: Focal nodular hyperplasia (FNH) is a benign liver tumor. The surgical indication of benign liver tumors has expanded due to the minimally invasive surgery (MIS) trend. Whether the tumor located in a specific location (such as under capsule, caudate lobe, left lateral lobe, etc.) or with psychological disorders can be used as an indication for surgery is rarely reported.This study explores the feasibility and safety of laparoscopic liver resection and provides potential surgical indications for FNH. Methods:A retrospective analysis of 29 FNH patients treated surgically at the First Affiliated Hospital of Soochow University from 2013 to 2021, with a median follow-up of 12 months. Data analysis included perioperative indication, mortalities, and prognosis. Results:All patients had surgery for FNH after pathology confirmed the diagnosis. The tumor's mean diameter was 5.5 cm (±1.8 cm). Laparoscopic liver resection was performed on 23 patients. Among them, five patients underwent right posterior lobe resection, and nine received robot-assisted laparoscopic lobectomy. one patient developed subdiaphragmatic fluid and required drainage. The anxiety and depression of all patients have been alleviated compared to the preoperative data(SCL-90).No patients had tumor recurrence or adverse outcomes related to liver resection during the follow-up period. Conclusion:Laparoscopic resection of FNH can be performed with few complications and a short retrieval length using reliable laparoscopic technology and skills. Surgical therapy for FNH is a safe procedure with low morbidity and an excellent prognosis.Resection can be an option for FNH patients with severe psychological problems or specific tumor location.

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Section: Discussionmentioning

confidence: 99%

Focal nodular hyperplasia: are the existing surgical indications sufficient?

Zhang

Qin

et al. 2022

Preprint

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“…A few reports have shown that pregnancy and long-term use of oral contraceptives may lead to larger nodules in size and clinical manifestations, indicating a possible association between FNH and estrogen levels [ 62 , 63 , 64 , 65 ]. Indeed, a research team demonstrated that most FNH lesions showed estrogen receptor expression [ 66 ].…”

Section: Pathogenesis Molecular Features and Associated Diseasesmentioning

confidence: 99%

Pedunculated Focal Nodular Hyperplasia: When in Doubt, Should We Cut It Out?

Tsalikidis,

Mitsala,

Pappas-Gogos

et al. 2023

JCM

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Focal nodular hyperplasia (FNH) is the second most common benign hepatic tumor and can rarely present as an exophytic solitary mass attached to the liver by a stalk. Most FNH cases are usually detected as incidental findings during surgery, imaging or physical examination and have a high female predominance. However, the pedunculated forms of FNH are particularly rare and commonly associated with severe complications and diagnostic challenges. Hence, our study aims to provide a comprehensive summary of the available data on the pedunculated FNH cases among adults and children. Furthermore, we will highlight the role of different therapeutic options in treating this clinical entity. The use of imaging techniques is considered a significant addition to the diagnostic toolbox. Regarding the optimal treatment strategy, the main indications for surgery were the presence of symptoms, diagnostic uncertainty and increased risk of complications, based on the current literature. Herein, we also propose a management algorithm for patients with suspected FNH lesions. Therefore, a high index of suspicion and awareness of this pathology and its life-threatening complications, as an uncommon etiology of acute abdomen, is of utmost importance in order to achieve better clinical outcomes.

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“…Focal nodular hyperplasia is the second most common benign liver tumor, occurring in 3% of adults 51 . The relationship between FNH and estrogen exposure is controversial, although tumor growth during pregnancy and subsequent regression postpartum has been reported 52 . Rare complications include intratumoral bleeding and rupture 52 .…”

Section: Liver Masses In Pregnancymentioning

confidence: 99%

“…The relationship between FNH and estrogen exposure is controversial, although tumor growth during pregnancy and subsequent regression postpartum has been reported 52 . Rare complications include intratumoral bleeding and rupture 52 . FNH is typically managed conservatively, although resection, embolization, or ablation can be considered in patients who are symptomatic 51,52 …”

Section: Liver Masses In Pregnancymentioning

confidence: 99%

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Liver pathology in pregnancy

Birkness-Gartman

Oshima

2021

Pathology International

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Liver dysfunction occurs in up to 3% of pregnancies and can be due to pregnancy‐associated liver injury, exacerbation of pre‐existing liver disease, or co‐incident with pregnancy. The most common form of pregnancy‐associated liver injury is intrahepatic cholestasis of pregnancy (ICP). This condition is typically benign and self‐limited, but is associated with fetal morbidity and mortality with high levels of serum bile acids. Acute fatty liver of pregnancy (AFLP) and the hypertensive disorders of pregnancy (including pre‐eclampsia, eclampsia, and hemolysis, elevated liver enzymes, and low platelets [HELLP] syndrome) are more commonly associated with maternal and fetal complications and may necessitate expedient delivery. Histologically, ICP shows nonspecific features of cholestasis, while AFLP and the hypertensive disorders have more characteristic histologic findings. While not a true liver disease, hyperemesis gravidarum can cause elevated liver enzymes. Pregnant patients are at increased risk of developing severe hepatitis E and herpesvirus infections, Budd–Chiari syndrome, and gallstones, and they may also experience worsening of known chronic liver disease. Mass lesions in pregnancy including hemangiomas, focal nodular hyperplasia, and hepatocellular adenomas and carcinomas can present unique challenges for diagnosis and management. This review will explore the pathophysiology, presentation, histologic features, and management of these conditions.

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Estrogen-Driven Growth of Focal Nodular Hyperplasia: Truth or Myth?

Cited by 6 publications

References 17 publications

Focal nodular hyperplasia: are the existing surgical indications sufficient?

Focal nodular hyperplasia: are the existing surgical indications sufficient?

Pedunculated Focal Nodular Hyperplasia: When in Doubt, Should We Cut It Out?

Liver pathology in pregnancy

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