Decision for Surgery of Focal Nodular Hyperplasia: Single-Center Experience of 17 Adult Cases

Abstract

Surgery is rarely a necessity for the removal of focal nodular hyperplasia (FNH) lesions. Diagnostic challenges and symptomatic lesions are common indications for surgery. This study was conducted for the purposes of analyzing the indications and results of liver surgeries, revealing FNH in further examinations from specimens sent to pathology. The patients that were operated for liver lesions revealed as FNH at pathological examinations at Ankara University Hospitals between October 2009 and March 2018 were included in this study. Twelve of the patients had some abdominal symptoms, with the remaining four having no reported symptoms. All patients were subjected to at least one imaging modality from computed tomography, ultrasonography or magnetic resonance imaging. Only three patients were diagnosed with certain FNH and were also symptomatic. No jaundice was observed in the group before surgery. Only one patient demonstrated mildly elevated preoperative liver enzyme levels. All patients underwent several types of hepatectomies except for two patients undergoing additional procedures such as pancreatoduodenectomy and cholecystectomy. Only three of the patients had postoperative complications including intraabdominal abscess, biliary leak and pulmonary embolism. No mortality occurred among the group. Surgery is rarely a necessity in the cases of FNH. However, surgical approach is generally preferred when the lesion is suspected to be a lesion other than FNH.

Keywords

• Focal Nodular Hyperplasia
• Premalignant Lesion
• Benign Disease
• Hepatectomy

Fokal Nodüler Hiperplazide Cerrahiye Karar Verme: On Yedi Erişkin Olgu ile Tek-Merkez Deneyimi

Abstract

Fokal nodüler hiperplazi (FNH) genellikle opere edilmez. Tanısal zorluklar ve semptomatik lezyonlar cerrahi için yaygın endikasyonlardır. Bu çalışma, karaciğer ameliyatları sonrası patoloji sonucu FNH olarak raporlanan olgularda ameliyat endikasyon ve sonuçlarının incelenmesi amacıyla yapılmıştır. Ekim 2009-Mart 2018 tarihleri arasında Ankara Üniversitesi Hastaneleri’nde opere edilen ve patolojisi FNH olarak raporlanan hastalar incelendi. Hastaların 12’sinde bazı karın semptomları vardı, dördünde ise herhangi bir semptom rapor edilmedi. Tüm hastalara bilgisayarlı tomografi, ultrasonografi veya manyetik rezonans görüntülemeden en az bir görüntüleme yöntemi uygulandı. Sadece üç hastaya kesin FNH tanısı konuldu ve bu hastalar aynı zamanda semptomatikti. Ameliyat öncesi grupta sarılık görülmedi. Sadece bir hastada ameliyat öncesi hafif yüksek karaciğer enzim seviyeleri görüldü. Pankreatoduodenektomi ve kolesistektomi gibi ek prosedürler uygulanan iki hasta dışında tüm hastalara çeşitli tiplerde hepatektomi uygulandı. Hastaların sadece üçünde intraabdominal apse, safra kaçağı ve pulmoner emboli gibi postoperatif komplikasyonlar gelişti. Mortalite izlenmedi. FNH olgularında cerrahi nadiren gereklidir. Ancak lezyonun FNH dışında bir lezyon olduğundan şüphelenildiğinde ve hasta semptomatikse genellikle cerrahi yaklaşım tercih edilir.

Keywords

• Fokal Nodüler Hiperplazi
• Premalign Lezyon
• Benign Hastalık
• Hepatektomi

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