FNH-like nodules: Possible precursor lesions in patients with focal nodular hyperplasia (FNH).
FNH-like nodules: Possible precursor lesions in patients with focal nodular hyperplasia (FNH).
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DOI：
10.1186/1476-5926-2-7
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发表时间：
2003-06-26
期刊：
影响因子：
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通讯作者：
Bioulac-Sage P
中科院分区：
文献类型：
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作者：
Lepreux S;Laurent C;Balabaud C;Bioulac-Sage P
局灶性结节性增生（FNH）的典型病变是一种良性肿瘤样肿块，其特征是肝细胞结节被纤维带分隔。高流量的孤立中央动脉和门静脉缺如使病变具有特征性的影像学表现。日常生活中的绝大多数情况都符合上述描述。通过成像技术或肉眼检查发现的额外小结节（直径从1-2 mm到15-20 mm）如果缺乏较大病变中定义的FNH的关键特征，则可能难以识别为FNH。本研究的目的是描述这些小结节的特征，并将其特征与相同标本中FNH的典型病变进行比较。8名患者接受了肝切除术，以切除诊断为FNH（1名患者）的肿块病变（“结节”）;性质不明的结节（5名患者）;或被认为是腺瘤或肝细胞癌的结节（2名患者）。通过成像技术发现的9个结节中有6个符合诊断典型FNH的组织病理学标准，至少部分结节; 2个结节对应于FNH的轻微形式（“轻微FNH”），1个结节对应于脂肪变性区域。虽然FNH被认为是在正常或接近正常的肝脏中发现的，但本研究发现，此外，在具有典型FNH结节的肝脏中存在各种类型的FNH样小结节和血管异常。各种类型的FNH样小结节（n = 8，直径2 - 20 mm）包括汇管区或间隔内不同程度的大量和/或增大的动脉，伴增生灶，轻微的小管反应和窦状扩张区域，伴有薄纤维带。血管异常包括不成对的动脉、动脉大于相关胆管的汇管区和窦状扩张区域。虽然这些小结节可以被认为是FNH的不充分型或流产型或腺瘤，但它们可以是FNH被识别和定义的大肿块病变的前兆。
The typical lesion of focal nodular hyperplasia (FNH) is a benign tumor-like mass characterized by hepatocytic nodules separated by fibrous bands. The solitary central artery with high flow and the absent portal vein give the lesions their characteristic radiological appearance. The great majority of cases seen in daily practice conform to the above description. Additional small nodules (from 1-2 up to 15-20 mm in diameter) detected by imaging techniques or on macroscopic examination may be difficult to identify as representing FNH if they lack the key features of FNH as defined in larger lesions. The aim of this study was to characterize these small nodules, and to compare their characteristics with those of typical lesions of FNH present in the same specimens. Eight patients underwent hepatic resections for the removal of a mass lesion ("nodule") diagnosed as: FNH (1 patient); nodules of unknown nature (5 patients); or nodules thought to be adenoma or hepatocellular carcinoma (2 patients). Six nodules out of 9 discovered by imaging techniques met histopathological criteria for the diagnosis of typical FNH, at least in parts of the nodule; 2 nodules corresponded to a minor form of FNH ("subtle FNH") and one nodule to a steatotic area. Although FNH was thought to be found in a normal or nearly normal liver, this study revealed that, in addition, there were various types of small FNH-like nodules and vascular abnormalities in the liver with typical FNH nodule. The various types of small FNH-like nodules (n = 8, diameter 2 to 20 mm) consisted of the association to various degrees of numerous and/or enlarged arteries in portal tracts or in septa, with hyperplastic foci, slight ductular reaction, and regions of sinusoidal dilatation, accompanied by thin fibrous bands. Vascular abnormalities consisted of unpaired arteries, portal tracts with arteries larger than the associated bile duct, and regions of sinusoidal dilatation. Although these small nodules can be considered as insufficient type or abortive forms of FNH, or adenoma, they can be precursors of the large mass lesions in which FNH was recognized and defined.