focal nodular hyperplasia of the liver
Introduction
Introduction to focal nodular hyperplasia of the liver Focal nodular hyperplasia of the liver is a rare benign lesion of the liver, and the cause of the disease is still unclear. Due to the development of imaging technology in recent years, reports of focal nodular hyperplasia of the liver have gradually increased. In the past, there have been many names in the literature, such as focal cirrhosis, liver hamartoma, hepatic inflammatory pseudotumor, etc. In 1958, it was named by Edmondson as focal nodular hyperplasia of the liver. The name was adopted in 1975 by the World Health Organization and the 1976 International Association for Liver Research. basic knowledge The proportion of sickness: 0.9% Susceptible people: no specific population Mode of infection: non-infectious complication:
Cause
Causes of focal nodular hyperplasia of the liver
(1) Causes of the disease
The exact cause of FNH has not been clarified. In animal experiments and clinical examinations, ovulation inhibitory preparations have been found to cause several changes in liver tissue. There are also examples of FNH in patients with FNH and female Cushing's syndrome during pregnancy, indicating the occurrence of FNH and sex hormones. Metabolic related, but in the literature reports, FNH not only appears in any age and gender, but also in women who do not take contraceptives, such as Foster reported 63 cases, including 43 women, clearly 7 cases of contraceptives ( 16.3%), 22 cases (51.2%) did not take contraceptives, so it is currently considered that ovulation inhibitors have no direct effect on the occurrence of FNH, only promote the existing liver lesions, another view that the occurrence of FNH may It is related to the reduction of blood supply caused by inflammation, trauma, etc., or the vascular malformation, which is caused by hepatocyte atrophy and compensatory hyperplasia of liver tissue. It is a manifestation of the limited "regeneration degeneration" of the liver. This view remains to be seen. Further confirmed.
(two) pathogenesis
In general, FNH is a clear, hard, non-enveloped, yellow-brown or light-brown solid mass, often located under the liver capsule, and the surface of the liver may be umbilical-shaped. The main pathological feature is the central lesion. Star scars are separated by radial fibers, which divide the lesion into many small leaves of varying sizes.
Microscopically, the nodules are composed of proliferating hepatocytes. The liver cells are rich in glycogen and the cytoplasm is lightly stained. The arrangement is in the form of a cord, with sinusoids and hepatic macrophages in between; and the radial fibrous tissue will be seen. Hepatocyte separation, fibrous tissue usually contains one or several arteries, arterial intima or middle fibrillar muscle layer is often mild hyperplasia; there are hyperplastic bile ducts in the fiber separation, and there are a lot of blood vessels and lymphocytes, leukocyte infiltration; often visible To varying degrees of cholestasis (capillary bile duct thrombosis, pseudo-xanthoma-like changes, copper deposition); necrosis and hemorrhage are rare in the lesion, and the wall of the vein is thickened to make the lumen eccentric or completely occluded without central vein Under the electron microscope, the structure of these proliferating hepatocytes was basically the same as that of normal hepatocytes. The only difference was that the intercellular space increased and the microvilli irregularly protruded into the enlarged gap.
Prevention
Liver focal nodular proliferative prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Hepatic focal nodular hyperplasia complications Complication
Complications such as spontaneous rupture or bleeding in FNG are extremely rare, and malignant changes generally do not occur.
Symptom
Symptoms of focal nodular hyperplasia of the liver Common symptoms Upper abdominal mass of the liver and hard upper abdomen diffuse tenderness right upper quadrant pain upper abdominal discomfort
About 75% of FNHL patients are asymptomatic and are often found accidentally during ultrasound or abdominal surgery. Symptomatic patients may present with pain in the right upper quadrant, discomfort, hepatomegaly or right upper abdomen mass, and the liver may be found under the right costal margin. Or a hard mass in the right upper abdomen, tenderness, smooth surface, moving up and down with the breath.
Clinically, according to the patient's good health, no hepatitis, no history of cirrhosis, combined with imaging examination, typical FNHL can be diagnosed by BUS, CT, MRI, but it is necessary to improve the understanding of such diseases, especially when the medical history When the results of imaging examination are inconsistent, it should be carefully identified to prevent misdiagnosis.
Examine
Examination of focal nodular hyperplasia of the liver
Liver function tests and AFP levels were generally normal due to non-specific clinical symptoms.
In addition to clinical symptoms, B-ultrasound, CT, MR and ECT examinations have limited qualitative value for FNH. Because FNH is similar to liver tissue density and lacks contrast, it is difficult to diagnose with the above-mentioned examination methods. Hepatic angiography and radionuclide colloid 99mTc Like some help, one-third of patients have typical manifestations of hepatic angiography, that is, the central vessels of the tumor are seen to travel radially, and the fibrous phase of the parenchyma is radially arranged, the boundary of the lesion is clear, and the radionuclide 99mTc is imaged. FNHL contains hepatic macrophages, which is characterized by normal or increased uptake of colloidal 99mTc, while hepatic adenomas are less abundant.
Accurate qualitative diagnosis relies on biopsy, and can be performed under the guidance of B-ultrasound percutaneous liver biopsy.
Diagnosis
Diagnosis and differential diagnosis of focal nodular hyperplasia of the liver
Mainly differentiated from hepatic adenoma, because the latter often have complications, tumors are easy to rupture and hemorrhage, often require surgical treatment, the main identification is based on pathological examination.
