A practical contribution to the diagnostics and treatment of focal nodular hyperplasia and adenomas in the liver from the perspective of a hepatologist, radiologist, pathologist and surgeon

Česká verzia

Authors: H. Gottfriedová ¹; E. Honsová ²; D. Cupalová ³; M. Oliverius ⁴; D. Kautznerová ³; L. Morávková ¹; J. Špičák ¹; P. Trunečka ⁵
Authors place of work: Klinika hepatogastroenterologie, IKEM, Praha ¹; Pracoviště klinické a transplantační patologie, IKEM, Praha ²; Pracoviště radiodiagnostiky a intervenční radiologie, IKEM, Praha ³; Klinika transplantační chirurgie, IKEM, Praha ⁴; Transplantcentrum, IKEM, Praha ⁵
Published in the journal: Gastroent Hepatol 2015; 69(1): 56-64
Category: Hepatologie: přehledová práce
doi: https://doi.org/10.14735/amgh201556

Summary

Focal nodular hyperplasia and adenomas are benign hepatocellular lesions. The risk of life‑ threatening bleeding and malignant transformation of adenomas require accurate diagnosis of both units and their differentiation not only from each other but also from other liver tumors. The progress in the area of imaging methods and particularly in the histopathological diagnosis leads to a more accurate differentiation using imaging methods, resection specimens and needle biopsies. Magnetic resonance imaging with a contrast medium plays an important role in the diagnostics, in the differentiation of adenoma subtypes and in the detection of adenoma complications; it also allows to establish differential diagnosis of focal nodular hyperplasia and adenoma. The use of genetic and immunohistochemical methods helps to distinguish adenoma subgroups with varying risk of hemorrhage and malignant transformation – this enables the application of an individualized surgical treatment in high risk adenomas and conservative treatment of small tumors with low risk of malignant transformation. The diagnosis is a result of a comprehensive assessment of the clinical and laboratory image, imaging methods and morphological evaluation. The therapeutic approach is individualized and requires multidisciplinary cooperation of experienced professionals.

Key words:
focal nodular hyperplasia – liver adenoma – subtypes of adenomas – diagnosis – treatment

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
8. 12. 2014

Accepted:
3. 2. 2015

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