Prenatal diagnosis of focal nodular hyperplasia

doi:10.3877/cma.j.issn.1672-6448.2020.11.006

Abstract

Abstract:

Objective

To assess the prenatal features of focal nodular hyperplasia and to analyze its pregnancy outcome.

Methods

The data of six cases of focal nodular hyperplasia, including prenatal ultrasonographic manifestations, laboratory examination, and pregnancy outcome, were retrospectively analyzed at the 901st Hospital of PLA, the Second Hospital of Anhui Medical University, and Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University from 2014 to 2019. The characteristics of sonograms and clinical guidelines were summarized.

Results

In all the six cases of fetal focal nodular hyperplasia, prenatal ultrasound showed a hepatic hypoechoic mass, with a regular shape (mostly oval), clear boundary, and no obvious capsule, and Color Doppler flow imaging showed normal intrahepatic blood vessels in the mass. All six cases had full-term live births, of whom one was operated on 14 days after birth and confirmed by pathology. One case was lost to follow-up, and the remaining five cases were reexamined at the age of 0.5 and 1 years, and the lesions gradually shrank to disappear. No other abnormalities were found in the six fetuses.

Conclusion

Intrahepatic vascular passage is an important clue for prenatal ultrasonography in diagnosing focal nodular hyperplasia of the fetal liver.

Key words: Ultrasonography, prenatal, Fetus, Focal nodular hyperplasia, Liver

Ruixia Tian, Zhuojun Wei, Lili Gu, Zhihui Cui, Feng Chen, Huaxuan Wen, Shengli Li. Prenatal diagnosis of focal nodular hyperplasia[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(11): 1070-1075.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2020.11.006

https://chaosheng.cma-cmc.com.cn/EN/Y2020/V17/I11/1070

Figures/Tables 4

References 20

1	Petrikovsky BM, Cohen HL, Scimeca P, et al. Prenatal diagnosis of focal nodular hyperplasia of the liver [J]. Prenat Diagn, 1994, 14(5): 406-409.
2	Kang J, Choi HJ, Yu E, et al. A case report of fetal telangiectatic focal nodular hyperplasia [J]. Pediatr Dev Pathol, 2007, 10(5): 416-417.
3	吴孟超. 肝脏外科学[M]. 2版. 上海: 上海科技教育出版社, 2000: 386-387.
4	von Schweinitz D. Management of liver tumors in childhood [J]. Semin Pediatr Surg, 2006, 15(1): 17-24.
5	Nguyen BN, Fléjou JF, Terris B, et al. Focal nodular hyperplasia of sive pathologic study of 305 lesions and recognition of new histologic forms [J]. Am J Surg Pathol, 1999, 23(12): 1441-1454.
6	De Luca G, Zamparelli M, Fadda C, et al. Focal nodular hyperplasia of the liver in infancy: a case report [J]. J Pediatr Surg, 2006, 41(2): 456-457.
7	葛亮，詹江华. 儿童肝脏局灶性结节性增生的病因机制及诊治进展 [J]. 中国小儿血液与肿瘤杂志, 2018, 23(2): 49-52.
8	杨泽萱，周柳英，邓颖. 产前超声诊断胎儿肝脏占位性病灶的临床价值 [J]. 诊断学理论与实践, 2017(2): 86-89.
9	胡嘉健，王焕民，韩炜. 小儿局灶性结节性肝脏增生临床诊治经验探讨 [J]. 临床小儿外科杂志, 2019(2): 112-117.
10	Makin E, Davenport M. Fetal and neonatal liver tumours [J]. Early Hum Dev, 2010, 86(10): 637-642.
11	Isaacs H Jr. Fetal and neonatal hepatic tumors [J]. J Pediatr Surg, 2007, 42(11): 1797-1803.
12	Mueller BU, Mulliken JB. The infant with a vascular tumor [J]. Semin Perinatol, 1999, 23(4): 332-340.
13	张丹丹，王军梅. 胎儿肝血管瘤的产前影像学诊断和管理 [J]. 浙江大学学报(医学版), 2019, 48(4): 439-445.
14	陶溢潮，聂敏，周江, 等. 产前超声诊断胎儿肝脏肿瘤临床分析 [J]. 中华全科医学, 2013, 11(4): 627-628.
15	李妹云. 胎儿肝母细胞瘤超声表现一例 [J/CD]. 中华医学超声杂志(电子版), 2010, 7(1): 131-132.
16	Nguyen BN, Fléjou JF, Terris B, et al. Focal nodular hyperplasia of the liver: a comprehensive pathologic study of 305 lesions and recognition of new histologic forms [J]. Am J Surg Pathol, 1999, 23(12): 1441-1454.
17	Yang Y, Fu S, Li A, et al. Management and surgical treatment for focal nodular hyperplasia in children [J]. Pediatr Surg Int, 2008, 24(6): 699-703.
18	黄刚，汤庆，樊丽红, 等. 肝脏局灶性结节增生25例临床分析 [J]. 重庆医学, 2010, 39(10): 1196-1200.
19	Ma IT, Rojas Y, Masand PM, et al. Focal nodular hyperplasia in children: an institutional experience with review of the literature [J]. J Pediatr Surg, 2015, 50(3): 382-387.
20	Ramírez-Fuentes C, Martí-Bonmatí L, Torregrosa A, et al. Variations in the size of focal nodular hyperplasia on magnetic resonance imaging [J]. Radiologia, 2013, 55(6): 499-504.

病例	孕妇年龄（岁）	孕周（周）	病灶部位大小（cm）	超声表现	MRI表现	妊娠结局随访时病灶大小（cm）	生后甲胎蛋白及肝功能检查
例1	29	37	肝右叶病灶5.1×3.7	胎儿右肝后叶下段局限性低回声区，边界清晰，后方回声稍增强，肝动、静脉正常走行其内	-	产后超声示肝右叶包块，大小约7.0×4.3，出生后14 d，手术切除，病理证实为肝FNH	甲胎蛋白升高
例2	25	35	肝右叶病灶2.7×2.9×2.5	肝右叶低回声病灶，彩色多普勒血流成像：病灶内可见血流穿行	-	产后2个月肝右叶可见高回声区，范围约4.5×2.5，边界清楚，无明显包膜，内可见较粗的横向走行血管，周边血管无明显挤压、移位；1岁随访时肝病灶消失	-
例3	33	38	肝右叶病灶5.4×5.2×3.0	肝内低回声病灶，边界清楚，内部回声均匀，有动脉和静脉直接穿行其中，胎儿羊水指数24.5 cm	-	1岁随访时肝病灶消失	-
例4	35	32	肝右前叶病灶3.6×2.0×3.4	肝内低回声，无明显包膜，病灶内可见肝血管穿行	-	1岁随访时肝病灶消失	-
例5	34	31	病灶大部分位于肝右叶，小部分位于肝左叶，大小7.2×6.2×5.1	低回声病灶，其内可见一支粗大血管进入病灶内，呈树枝状分叉	肝右叶巨大等T1、稍长T2信号占位，示血管影穿行于病灶内	生后31 d，肝内显示多个偏高回声包块，最大6.5×4.7×5.9；3岁随访时肝体积正常，内未见明显占位病灶	甲胎蛋白阴性，肝功能正常
例6	31	37	肝右叶病灶，3.7×3.1×3.2	低回声病灶，边界清，其内可见一支粗大血管进入病灶内，可见分支	肝右叶类圆形稍长T1、稍长T2信号占位，呈浅分叶状，边缘清晰，病灶内可见少许条状更长T2信号	生后3 d，肝内显示多个高回声包块，最大5.3×4.6×4.5；生后3个月随访，肝内3.9×3.7×3.4低回声区，近似周围肝回声；1岁随访时，肝体积正常，内未见明显占位病灶	甲胎蛋白阴性，肝功能正常

病例	孕妇年龄（岁）	孕周（周）	病灶部位大小（cm）	超声表现	MRI表现	妊娠结局随访时病灶大小（cm）	生后甲胎蛋白及肝功能检查
例1	29	37	肝右叶病灶5.1×3.7	胎儿右肝后叶下段局限性低回声区，边界清晰，后方回声稍增强，肝动、静脉正常走行其内	-	产后超声示肝右叶包块，大小约7.0×4.3，出生后14 d，手术切除，病理证实为肝FNH	甲胎蛋白升高
例2	25	35	肝右叶病灶2.7×2.9×2.5	肝右叶低回声病灶，彩色多普勒血流成像：病灶内可见血流穿行	-	产后2个月肝右叶可见高回声区，范围约4.5×2.5，边界清楚，无明显包膜，内可见较粗的横向走行血管，周边血管无明显挤压、移位；1岁随访时肝病灶消失	-
例3	33	38	肝右叶病灶5.4×5.2×3.0	肝内低回声病灶，边界清楚，内部回声均匀，有动脉和静脉直接穿行其中，胎儿羊水指数24.5 cm	-	1岁随访时肝病灶消失	-
例4	35	32	肝右前叶病灶3.6×2.0×3.4	肝内低回声，无明显包膜，病灶内可见肝血管穿行	-	1岁随访时肝病灶消失	-
例5	34	31	病灶大部分位于肝右叶，小部分位于肝左叶，大小7.2×6.2×5.1	低回声病灶，其内可见一支粗大血管进入病灶内，呈树枝状分叉	肝右叶巨大等T1、稍长T2信号占位，示血管影穿行于病灶内	生后31 d，肝内显示多个偏高回声包块，最大6.5×4.7×5.9；3岁随访时肝体积正常，内未见明显占位病灶	甲胎蛋白阴性，肝功能正常
例6	31	37	肝右叶病灶，3.7×3.1×3.2	低回声病灶，边界清，其内可见一支粗大血管进入病灶内，可见分支	肝右叶类圆形稍长T1、稍长T2信号占位，呈浅分叶状，边缘清晰，病灶内可见少许条状更长T2信号	生后3 d，肝内显示多个高回声包块，最大5.3×4.6×4.5；生后3个月随访，肝内3.9×3.7×3.4低回声区，近似周围肝回声；1岁随访时，肝体积正常，内未见明显占位病灶	甲胎蛋白阴性，肝功能正常

[1]	Xining Wu, Yunshu Ouyang, Yixiu Zhang, Hua Meng, Zhonghui Xu, Peipei Zhang, Ke Lyu. Application of fetal echocardiography in prenatal management of fetuses with positive maternal anti-SSA/Ro-SSB/La antibodies [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1056-1060.
[2]	Shuihua Yang, Guidan He, Guican Qin, Mengfeng Liang, Yanhe Luo, Xueqin Li, Juansong Tang. Echocardioimagedata characteristics of fetal isolated total anomalous pulmonary venous connection and application of high definition flow imaging and spatio-temporal image correlation [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1061-1067.
[3]	Dan Han, Ting Wang, Huan Xiao, Lirong Zhu, Jingyu Chen, Yi Tang. Diagnostic value of contrast enhanced ultrasound versus contrast enhanced computed tomography in benign and malignant liver lesions in children [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 939-944.
[4]	Tingting Liu, Yanbing Lin, Shan Wang, Murong Chen, Zijian Tang, Dongling Dai, Bei Xia. Evaluation of metabolic dysfunction-associated fatty liver disease in children by ultrasound-guided attenuation parameter [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 787-794.
[5]	Jingjing Zhang, Bowen Zhao, Mei Pan, Xiaohui Peng, Yankai Mao, Chenke Pan, Lingyan Zhu, Linlin Zhu, Qiuye Lan. Evaluation of fetal pulmonary development using McGoon index measured by fetal echocardiography [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 860-865.
[6]	Heng Lyu, Licong Dong, Haiqin Xie, Zhuofei Zhao, Li Liu, Desheng Sun. CT-ultrasound comparison for evaluating missed diagnosis of focal liver lesions by ultrasound: a single-center cross-sectional quality control survey [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(07): 712-716.
[7]	Peng Xu, Jun Li, Weilun Gao, Zheng Wang, Shen Pang, Chunni Li, Ting Zhu. Application of fast rotary scanning method in fetal echocardiography [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(07): 761-766.
[8]	Xiaolin Ye, Yunfei Liu, Mingquan Pang, Haijiu Wang, Li Ren, Lizhao Hou, Wenhao Yu, Zhixin Wang, Haining Fan. Research progress on the sources and regulatory mechanisms of liver regenerative cells [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 96-99.
[9]	Xu Tang, Bing Han, Wei Liu, Ruxing Chen. Analysis of risk factors for metachronous liver metastases after radical colorectal cancer surgery and construction of a predictive model [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 16-20.
[10]	Qian Yang, Cuifang Li, Wanqiu Zhang. Analysis of short-term and long-term prognosis and influencing factors of primary liver cancer with spontaneous ruptured hemorrhage after emergency TACE surgery [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 33-36.
[11]	Jianmei Li, Jingjuan Deng, Qian Yang. Safety and follow-up evaluation of the combined treatment of hepatocellular carcinoma with hepatic cirrhosis and portal hypertension [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 41-44.
[12]	Fangyuan Wu, Xia Sun, Changfeng Lin, Zhensheng Zhang. Risk factors of HBV-associated cirrhosis complicated with acute upper gastrointestinal bleeding [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 45-47.
[13]	Xin Lu, Jiayi Xu, Yang Liu, Qin Yang, Wenwen Ju, Yinglong Xu. Comparison of the effects of early LC and PTCD continuous LC on liver function and prognosis of patients with acute cholecystitis [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(06): 648-650.
[14]	Daya Zhang, Shiju Chen, Runxiang Chen, Xiaodong Zhang, Da Li, Feihu Bai. Role of intestinal microecological dysregulation in development of metabolic-associated fatty liver disease [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(07): 828-833.
[15]	Fanbiao Kong, Jianrong Yang. Progress in understanding of relationship between underlying liver diseases and liver metastasis of colorectal cancer [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(07): 818-822.

Please choose a citation manager

Content to export