Focal nodular hyperplasia

Case contributed by Dr Anil Geetha Virupakshappa

Presentation

Right upper abdominal pain.

Patient Data

Age: 25 years
Gender: Female
mri

A fairly well-defined 6.0 x 5.0 x 5.2cm lesion at segment VIII of liver appearing hypointense on T2WI with central hyperintense scar. The lesion shows intense arterial enhancement with delayed enhancement of the central scar which typical/characteristic feature of fibronodular hyperplasia. The lesion shows persistent enhancement on portal venous phase. No contrast washout. Background liver is non cirrhotic. No features to suggest fibrolamellar HCC or adenoma. No calcification or hemorrhage.  No other similar lesion.

No biliary tree dilatation. Gallbladder, CBD, portal vein, hepatic veins, pancreas, spleen and kidneys appear normal. No ascites or lymphadenopathy.

Case Discussion

Focal nodular hyperplasia is typically seen in you female patients, especially if they are on oral contraceptives. This patient's liver function tests and serum alpha-fetoprotein levels were normal.

Differential diagnosis are hepatic adenoma, fibrolamellar HCC, hypervascular metastasis and hemangioma.

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