Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 27, 2021; 13(10): 1450-1458
Published online Oct 27, 2021. doi: 10.4254/wjh.v13.i10.1450
Focal nodular hyperplasia associated with a giant hepatocellular adenoma: A case report and review of literature
Sérgio Gaspar-Figueiredo, Amaniel Kefleyesus, Christine Sempoux, Emilie Uldry, Nermin Halkic
Sérgio Gaspar-Figueiredo, Amaniel Kefleyesus, Emilie Uldry, Nermin Halkic, Department of Visceral Surgery, Lausanne University Hospital, Lausanne 1011, Switzerland
Christine Sempoux, Department of Pathology, Lausanne University Hospital, Lausanne 1011, Switzerland
Author contributions: Gaspar-Figueiredo S and Kefleyesus A performed the literature review, collected all the data related to the case report, and recorded/edited the video-vignette related to the case report; Sempoux C did the anatomopathological examination/appraisal; Halkic N and Uldry E did the surgical appraisal; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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:
Corresponding author: Nermin Halkic, MD, PhD, Chief Doctor, Professor, Department of Visceral Surgery, Lausanne University Hospital, Rue du Bugnon 46, Lausanne 1011, Switzerland.
Received: April 25, 2021
Peer-review started: April 25, 2021
First decision: June 4, 2021
Revised: June 15, 2021
Accepted: August 31, 2021
Article in press: August 31, 2021
Published online: October 27, 2021

Focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) are well-known benign liver lesions. Surgical treatment is usually chosen for symptomatic patients, lesions more than 5 cm, and uncertainty of diagnosis.


We described the case of a large liver composite tumor in an asymptomatic 34-year-old female under oral contraceptive for 17-years. The imaging work-out described two components in this liver tumor; measuring 6 cm × 6 cm and 14 cm × 12 cm × 6 cm. The multidisciplinary team suggested surgery for this young woman with an unclear HCA diagnosis. She underwent a laparoscopic left liver lobectomy, with an uneventful postoperative course. Final pathological examination confirmed FNH associated with a large HCA. This manuscript aimed to make a literature review of the current management in this particular situation of large simultaneous benign liver tumors.


The simultaneous presence of benign composite liver tumors is rare. This case highlights the management in a multidisciplinary team setting.

Keywords: Liver, Focal nodular hyperplasia, Hepatocellular adenoma, Composite tumor, Video vignette, Case report

Core Tip: Focal nodular hyperplasia and hepatocellular adenoma (HCA) are frequent but non-malignant tumors. There is rarely indication for surgery. Combination of these two masses is a very unusual situation. Their diagnosis is mainly based on radiology. Oral contraception is a risk factor for HCA. Malignant transformation of HCA is the predominant argument for surgery. All these cases, especially composite tumors, must be discussed in a multidisciplinary team.