fnh肝局灶性结节性增生

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1、肝局灶性结节性增生Focalnodularhyperplasia(FNH)OutlineFNHaccountsforapproximately8%ofallprimaryhepatictumorandisthesecondmostcommonbenignlivertumorafterhemangioma.Thisbenigntumouroccursmostcommonlyinwomenaged20–50years,butmayoccurinbothmenandwomenatanyage,withmultiplelesionsbe

2、ingfoundin20percentofcases.FNHOralcontraceptive口服避孕药useisassociatedwithFNHbuttheresponsibilityoforalcontraceptivesintheoccurrenceofthelesionhasnotbeendemonstrated.ClinicalsymptomsFNHisusuallyanincidentalfindingatimagingandonlyone-thirdarediscoveredbecauseofclinicalsy

3、mptomssuchasmildepigastricpainordiscomfortandorpalpableabdominalmass.Bloodlivertestsarenormalinhalfofthecasesandshowonlyincreasedinserumgamma-glutamyl-transpeptidase血清r-谷氨酰转肽酶activityinmostoftheremnants.well-circumscribedlobulatedmasswithcentralscar(arrow)andradiatin

4、gseptations.PathologicalappearanceFNHisdefinedasanodulecomposedofbenign-appearinghepatocytesoccurringinaliverthatisotherwisehistologicallynormal.FNHisahyperplasticliverparenchyma（增生性肝实质）subdividedintonodulesbyfibrousseptathatmayformstellatescars（星状瘢痕）.Thelesionisusua

5、llysolitary(80%)andmeasureslessthan5cmindiameter.Occasionally,FNHispedunculated(蒂).Photomicrographofhistopathologicspecimenshowsregionsofnodularhepatocellularproliferationseparatedbyradiatingbandsandsurroundingmyxomatousscar(arrows).Themarginissharp,oftenlobulatedand

6、nocapsuleispresent.Hemorrhageandnecrosisarerare.Atmicroscopy,thecentralfibroticzoneisdenseconnectivetissue（致密结缔组织）whichcontainsnumerousabnormallythickwalledarteries.Markedproliferationofbiliarystructuressurroundedbyinflammatorycellsisobservedwithinandattheperiphery（边

7、缘）ofthefibrousseptae.Kupffercellsarealsoseenwithinthelesion.FNHclassic(80%)non-classic(20%)(a)telangiectaticFNH,(b)withatypia,(c)mixedhyperplasticandadenomatousFNHDiagnosis（CT）NonenhancedCTscansFNHisdemonstratedasafocalhypodenseorisodensemasscomparedwithnormalliver.A

8、centralhypodensescarisdepictedinonlyone-thirdofthecases.Calcificationswithinthecentralscarareveryrareandobservedinonlyabout1%ofthec