Treatment of a non-typical hepatic pseudolesion complicated by greatly elevated alpha fetoprotein: case report and literature review

Liu, Xiaolong; Zhang, Lingyan; Li, Fuqiang; Liu, Yonghong; Wei, Qingzhu; Liu, Lixin; Cui, Haiyan

doi:10.1186/1477-7819-11-238

Cited by 3 publications

(3 citation statements)

References 23 publications

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“…[19,20] AFP can be increased slightly (up to 100 ng/ml) in liver cirrhosis and in chronic hepatitis as well, [21] but also in pregnancy or teratoma. [22] AFP is typically not elevated in a FNH but some rare cases with elevated AFP in FNH have been reported in a range of 40 -60 ng/ml. [23,24] One assumes that in these cases AFP expression is caused by a regenerative process due to features of progenitor cells within the FNH or even in the non-lesional adjacent liver.…”

Section: Discussionmentioning

confidence: 99%

Hepatocellular Carcinoma Mimicking Focal Nodular Hyperplasia

Gröger

2024

JCSR

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Focal nodular hyperplasia (FNH) is a common benign liver lesion, mostly solitary, and with no evidence of malignant transformation over time. The diagnosis can usually be made by imaging modalities with distinct features in magnetic resonance imaging (MRI) and computed tomography (CT) scans. We present a case series of three patients with solitary liver tumors which were, based on radiological features, first diagnosed to be large FNH. The patients were sent to our center for second opinion and probable treatment. Indication for resection was given because of nonconclusive radiologic imaging in the first, substantial growth progression in the second and elevated alpha fetoprotein (AFP) in the third case. Histology revealed well to poor differentiated hepatocellular carcinoma (HCC). FNH tends to show a distinct pattern in imaging modalities, but HCC can mimic FNH. The MRI-scan using hepatotropic contrast agent is the most sensitive imaging modality to diagnose FNH. AFP is usually not elevated in FNH. Asymptomatic FNH does not require surgery but a reliable diagnosis is crucial. In case of an un-certain diagnosis surgery should be offered to patients. In cases with a progression in size, an elevated level of AFP should be suspicious. Generally, an over-therapy via surgery should be avoided and follow-ups of a newly diagnosed FNH including measurement of AFP are advisable to detect alterations.

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Section: Discussionmentioning

confidence: 99%

Hepatocellular Carcinoma Mimicking Focal Nodular Hyperplasia

Gröger

2024

JCSR

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“…An increased level of AFP is usually associated with HCC and it used widely for screening in high-risk patients and for HCC follow-ups [18]. AFP can be increased slightly (up to 100 ng/ml) in liver cirrhosis and in chronic hepatitis as well [19], but also in pregnancy or teratoma [20]. AFP is typically not elevated in a FNH but some rare cases with elevated AFP in FNH have been reported in a range of 40-60 ng/ml [21,22].…”

Section: Discussionmentioning

confidence: 99%

Hepatocellular Carcinoma Mimicking Focal Nodular Hyperplasia

Gröger,

Hahn,

Straub

et al. 2023

Preprint

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Backround: FNH is a common benign liver lesion, mostly solitary, and with no evidence of malignant transformation over time. The diagnosis can usually be made by imaging modalities with distinct features in MRI- and CT-scans. Case series: We present a case series of three patients with solitary liver tumors which were highly suspicious to be large FNH, based on radiological features. The patients were sent to our center for second opinion and probable treatment. Indication for resection was given because of nonconclusive radiologic imaging in the first, substantial growth progression in the second and elevated AFP in the third case. Histology revealed well to poor differentiated HCCs. Discussion: FNH tends to show a distinct pattern in imaging modalities, but HCC can mimic FNH. The MRI-scan using hepatotropic contrast agent is the most sensitive imaging modality to diagnose FNH. AFP is usually not elevated in FNH. Asymptomatic FNH does not require surgery but a reliable diagnosis is crucial. In case of an uncertain diagnosis surgery should be offered to patients. Conclusion: In cases with a progression in size, an elevated level of AFP should be suspicious. A second opinion at a center for hepato-biliary surgery with HCC/FNH-experienced radiologists and surgeons is reasonable. Generally, an over-therapy via surgery should be avoided and follow-ups of a newly diagnosed FNH including measurement of AFP are advisable to detect alterations.

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“…Descriptions in the literature are very rare. 6,7 French Beaujon's team described a case of FNH associated with high serum AFP. It was hypothesized that, as FNH is associated with some features of progenitor cells, regenerative process can lead to an elevated serum AFP concentration.…”

Section: Discussionmentioning

confidence: 99%

Alpha‐fetoprotein and focal nodular hyperplasia: An unconventional couple

et al. 2021

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We report the case of a 36‐year‐old patient who was initially managed for gynecomastia. The first biological analyses showed a moderately elevated alpha‐fetoprotein (AFP) level. After an endocrine etiology was excluded, an abdominal computed tomography scan showed typical focal nodular hyperplasia (FNH) proven by biopsy and showing expression of AFP in FNH cells. After follow‐up for 24 months, the serum AFP and liver radiology remained unchanged. The association between an elevated AFP and FNH is rarely described in the medical literature.

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Treatment of a non-typical hepatic pseudolesion complicated by greatly elevated alpha fetoprotein: case report and literature review

Cited by 3 publications

References 23 publications

Hepatocellular Carcinoma Mimicking Focal Nodular Hyperplasia

Hepatocellular Carcinoma Mimicking Focal Nodular Hyperplasia

Hepatocellular Carcinoma Mimicking Focal Nodular Hyperplasia

Alpha‐fetoprotein and focal nodular hyperplasia: An unconventional couple

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