Pedunculated focal nodular hyperplasia in a healthy toddler

Abstract

Focal nodular hyperplasia (FNH) is a benign hepatic tumor rarely seen in pediatric patients, with most cases reported in school-aged children with a history of malignancy, liver disease, chemotherapy, or hematopoietic stem cell therapy. Despite having advanced radiographic imaging, diagnosing FNH before surgical resection can be difficult. We report a rare case of pedunculated FNH presenting as a large abdominal mass palpated on physical exam in a healthy 3-year-old girl with no history of malignancy or underlying liver disease. Ultrasound, computed tomography, and magnetic resonance imaging (MRI) did not demonstrate the typical imaging characteristics of FNH, because the mass was pedunculated with a poorly visualized central scar. Because approximately 75% of all primary hepatic tumors in this age group are malignant, this report also discusses the importance of adding hepatobiliary phase imaging with MRI to avoid, if possible, the need for biopsy or surgical resection of a benign hepatic tumor.

Pedunculated focal nodular hyperplasia of the liver in a healthy child born following in vitro fertilization: a case report and review of the literature

“…reported a 26-year-old female presenting with an acute abdomen caused by pedicle torsion of a pedunculated FNH [ 6 ]. FNH is mainly reported in children with certain risk factors, such as chemotherapy, hematologic cancers, underlying liver disease, and history of radiotherapy; however, a previous case reported a healthy child with no medical history but who was born prematurely [ 7 ]. We experienced FNH in a child who was born following IVF, and we assume that there might be a correlation between IVF and FNH in a healthy child.…”

“…The magnetic resonance imaging with hepatocyte scintigraphy with a sensitivity and specificity of 99% and 100% is the most accurate imaging modality for diagnosing the FNH. Using hepatocyte specific contrast agents, such as gadobenate dimeglumine, makes the lesion hyperintense relative to the normal liver parenchyma, which is particularly common in FNH [ 1 , 7 , 11 ]. Even using the imaging modalities, due to challenges in diagnosing FNH, especially the pedunculated form, sometimes biopsy may be needed.…”

“…Bile ducts and Kupffer cells may also be present. Both hematoxylin and eosineosin (H&E) and reticulin stains can be helpful in diagnosing the tissue accurately [ 1 – 3 , 7 , 12 ]. A summary of the previously reported cases of the pedunculated FNH is presented in Table 1 .…”

“…(2017) [ 16 ] Male/32 Asymptomatic 8 cm Seg 4, 5 Elevated CRP, WBC, AST, and ALT CT, MRI, and in the readmission due to rupture of the lesion a hepatic angiography was also done Conservative management at first but due to rupture of the lesion patient underwent surgery No complication after surgery No Koolwal et al . (2018) [ 7 ] Female/3 Abdominal distension 5.9 cm Right hepatic lobe Normal US, CT, and MRI Surgery N/A No (history of preterm birth) Martiniuc et al . (2018) [ 13 ] Female/40 Asymptomatic 4.2 cm × 5 cm Seg 3 Normal US and contrast enhanced CT Surgery No complications No Navarini et al .…”

Is there any special imaging finding in a pedunculated focal nodular hyperplasia with suspected torsion?

“…Focal nodular hyperplasia [1][2][3] is a benign liver tumor that usually does not require surgery [4]. The diagnosis is challenging for rare pedunculated forms of www.ijcasereportsandimages.com…”