Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2016; 22(47): 10461-10464
Published online Dec 21, 2016. doi: 10.3748/wjg.v22.i47.10461
Complete spontaneous regression of giant focal nodular hyperplasia of the liver: Magnetic resonance imaging evaluation with hepatobiliary contrast media
Giuseppe Mamone, Settimo Caruso, Kelvin Cortis, Roberto Miraglia
Giuseppe Mamone, Settimo Caruso, Roberto Miraglia, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), 90127 Palermo, Italy
Kelvin Cortis, Medical Imaging Department, Mater Dei Hospital, MSD2090 Msida, Malta
Author contributions: Mamone G designed this paper with input from Miraglia R; Caruso S wrote this paper with Mamone G and selected the pictures; Cortis K reviewed the first draft of the article and the bibliography; Miraglia R critically reviewed the article and approved the final version to be submitted; Miraglia R takes responsibility for the integrity and the accuracy of the data.
Institutional review board statement: The Institutional Research Review Board reviewed and approved this case report, with waiver of the informed consent.
Informed consent statement: A written informed consent to the MR procedures was obtained after a full explanation of the purpose and nature of the procedure.
Conflict-of-interest statement: We declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Giuseppe Mamone, MD, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127 Palermo, Italy. gmamone@ismett.edu
Telephone: +39-91-2192292 Fax: +39-91-2192344
Received: June 20, 2016
Peer-review started: June 22, 2016
First decision: August 22, 2016
Revised: September 5, 2016
Accepted: September 28, 2016
Article in press: September 28, 2016
Published online: December 21, 2016
Processing time: 181 Days and 21.5 Hours
Abstract

Focal nodular hyperplasia (FNH) of the liver is a benign lesion occurring in 0.6%-3% of the general population that probably reflects a local hyperplastic response of hepatocytes to a vascular abnormality. Most lesions are diagnosed incidentally and the natural history of the disease remains largely unknown. It has been shown that most FNH remain stable, or even regress, over a long follow-up period. We present a patient with FNH of the liver who was followed up for 7 years. A 26-year-old woman with a 5-year history of oral contraceptive use was referred to our hospital in February 2005 for further examination of a liver tumour. The diagnosis of FNH was made using magnetic resonance (MR) imaging with hepatospecific contrast media; this technique allows a correct diagnosis, in particular distinguishing FNH from hepatic adenoma, avoiding an invasive procedure such as the lesion biopsy. After 7-year from the diagnosis, we observed the complete spontaneous regression of the lesion by enhanced MR scanning. In this patient, discontinuation of oral contraceptive use and two childbirths may have influenced the natural history of FNH. To our knowledge, in the English literature there is no report illustrating a complete regression of giant FNH but only studies of decreasing in size. The present case suggests that a young patient with giant FNH should be managed conservatively rather than by resection, because FNH has the potential for spontaneous regression.

Keywords: Focal nodular hyperplasia; Regression; Magnetic resonance; Oral contraceptives; Pregnancy

Core tip: We present a patient with focal nodular hyperplasia (FNH) of the liver who was followed up for 7 years. A 26-year-old woman with a 5-year history of oral contraceptive use was referred to our hospital in February 2005 for further examination of a liver tumour. The diagnosis of FNH was made using magnetic resonance (MR) imaging with hepatospecific contrast media. After 7-year from the diagnosis, we observed the complete spontaneous regression of the lesion by enhanced MR scanning. In this patient, discontinuation of oral contraceptive use and two childbirths may have influenced the natural history of FNH.