Hepatic focal nodular hyperplasia in children previously treated for a solid tumor - Incidence, risk factors, and outcome
Hepatic focal nodular hyperplasia in children previously treated for a solid tumor - Incidence, risk factors, and outcome
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DOI：
10.1002/cncr.11452
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发表时间：
2003-06-15
期刊：
影响因子：
6.2
通讯作者：
Hartmann, O
中科院分区：
文献类型：
--
作者：
Bouyn, CID;Leclere, J;Hartmann, O
背景肝结节的检测，特别是在以前的恶性肿瘤治疗的患者，提出了一个诊断的困境。肝脏局灶性结节增生是一种少见的良性肿瘤，在儿童中必须与肝脏的恶性病变相鉴别。FNH的病因不明，其发病机制知之甚少。FNH可能是局部血管异常和循环障碍的反应。本研究的目的是确定既往接受过恶性肿瘤治疗的儿童发生FNH的危险因素。目前的回顾性研究检查了14例FNH的儿童患者谁以前曾接受过治疗的恶性肿瘤。诊断是基于临床和放射学表现，并在四个病例中得到组织学证实。78%的患者在常规检查中偶然发现FNH病变。与一般儿科人群的发病率相比，FNH的发病率在当前系列中特别高（0.45%）。高剂量的烷化剂（例如，白消安或美法仑）、静脉阻塞性疾病和肝脏放疗可能是导致血管内皮损伤和随后的局部循环障碍的原因。FNH的特点是发现后无并发症，因此，建议密切随访。FNH似乎是有恶性肿瘤病史的儿童医源性血管疾病的晚期并发症。(C)2003年美国癌症协会。
BACKGROUND. The detection of hepatic nodules, particularly in patients treated for a previous malignancy, raises a diagnostic dilemma. Focal nodular hyperplasia (FNH) of the liver is an uncommon, benign tumor in children and must be differentiated from malignant hepatic lesions. The etiology of FNH is obscure, and its pathogenesis is poorly understood. FNH may be a reaction to localized vascular abnormalities and circulatory disturbances. The goal of the current study was to identify risk factors for the occurrence of FNH in children who had received prior treatment for a malignant tumor.METHODS. The current retrospective study examined 14 cases of FNH in pediatric patients who previously had been treated for a malignancy. Diagnosis was based on clinical and radiologic findings and was proven histologically in four cases.RESULTS. FNH lesions were discovered by chance during routine examination in 78% of patients. The incidence of FNH was particularly high in the current series (0.45%) compared with the incidence in the general pediatric population. High doses of alkylating agents (e.g., busulfan or melphalan), venoocclusive disease, and liver radiotherapy may be responsible for injury to the vascular endothelium and subsequent localized circulatory disturbances. FNH is characterized by the absence of complications after its detection; therefore, only close follow-up is recommended.CONCLUSIONS. FNH appears to be a late complication of an iatrogenic vascular disease in children with a history of malignancy. (C) 2003 American Cancer Society.