Multiple focal nodular hyperplasia occurs in approximately 20-25% of patients with focal nodular hyperplasia (FNH). It is defined by The International Working Party as consisting of two or more FNHs in combination with 1:
- liver haemangioma or
- vascular malformations (most frequent types: hepatic haemangioma, arterial dysplasia, portal vein atresia, berry aneurysms or pulmonary arterial hypertension) or
- intracranial tumours
Associations
- meningiomas
- astrocytomas
- liver haemangiomata (20% of cases)
- neoplasia of other organs: phaeochromocytomas and GIST
- Klippel Trenauanay Weber syndrome
Differential diagnosis
Imaging differential considerations include:
-
multifocal HCC: can be a challenging differential
- HCC has a true fibrotic capsule present in 60-80% of cases, but FNH may have a pseudocapsule composed of compressed parenchyma, perilesional vessels and inflammation
- multiple hepatic adenomas: do not tend to have a central scar and majority of them contain fat
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