What is Changing in Indications and Treatment of Focal Nodular Hyperplasia of the Liver. Is There any Place for Surgery?

ABSTRACT Focal nodular hyperplasia (FNH) is a common benign liver tumor, which occurs in the vast majority of the cases in young women. FNH represents a polyclonal lesion characterized by local vascular abnormalities and is a truly benign lesion without any potential for malignant transformation. A retrospective single institution analysis of 227 FNH patients, treated from 1990 to 2016 and a review of studies reporting surgical therapy of overall 293 patients with FNH was performed. Indications for resection with a focus on diagnostic workup, patient selection, surgical mode and operative mortality and morbidity have been analysed. Ninety three patients underwent elective hepatectomy and 134 patients observation alone, where median follow-up was 107 months. Postoperative complications were recorded in 14 patients, 92% of patients reported an improvement with respect to their symptoms. Overall among 293 patients underwent surgery in the series, included to this review, there was a morbidity of 13%, where median follow-up was 53 months. Systematic follow-up remains the gold standard in asymptomatic patients with FNH. Flowever elective surgery should be considered in symptomatic patients, in those with marked enlargement and in case of uncertainty of diagnosis. Surgery for FNH is a safe procedure with low morbidity and very good long term results as far as quality of life after surgery is concerned and surely an integral part of the modern management of FNH.

Hipertensión arterial maligna e hiperaldosteronismo hiperreninémico: reporte de un caso / Malignant arterial hypertension and hyperreninemic hyperaldosteronism: a case report

Se presenta el caso de una mujer de 28 años de edad, hospitalizada por hipertensión arterial severa, edema pulmonar e hipokalemia. se encontró hiperaldosteronismo hiperreninémico e imagen de una lesión nodular en la glándula suprarrenal izquierda, la cual fue extirpada mediante cirugía laparoscópica. El estudio histológico demostró hiperplasia macronodular cortical y en el postoperatorio, hubo retorno progresivo de la hipertensión e hipokalemia

Carcinoma hepatocelular variedad fibrolamelar metastásico en menores de 20 años: Reporte de 2 casos tratados con intención curativa y revisión de la literatura / Fibrolamellar liver carcinoma: Report of two cases

Fibrolamellar hepatocellular carcinoma (FLC) is a rare histologic variant of hepatocellular carcinoma that appears most commonly in teenagers and young adults. The diagnosis is often made incidentally and surgical resection is the only curative treatment. Here we report two cases of incidental FLC involving a 19 year-old male, initially diagnosed with screening abdominal ultrasound, and a 14 year-old female that presented with abdominal pain. Diagnostic workup consisted of abdominal PET/CT and MRI Imaging studies and tissue diagnosis was confirmed with percutaneous liver biopsy. Both patients were treated with radical liver resection/tumor excision. However, tumor recurrence was observed in both during short-term follow-up. The male patient was treated successfully with surgical treatment however the female patient succumbed top regression of disease.

Tumores hepáticos benignos / Benign hepatic tumors

Racional - A maioria dos tumores hepáticos benignos são achados incidentais durante a ultra-sonografia abdominal. As formas mais encontradas são: hemangioma, hiperplasia nodular focal, e adenoma. Objetivo - Descrever quatro casos de pacientes portadores de tumores hepáticos benignos. Casuística e Métodos - Quatro pacientes portadores de doença hepática benigna foram submetidos a ressecção hepática, sendo um do sexo masculino e três do sexo feminino. Relacionaram-se no estudo: abordagem diagnóstica, modalidade cirúrgica, extensão da ressecção, perda sanguínea, sexo, histologia tumoral e complicaçõespós-operatória...

Hiperplasia nodular focal hepática / Liver focal nodular hyperplasia

Se presenta la experiencia en el manejo de 4 casos de hiperplasia nodular focal hepática, 2 de ellos de pequeños tamaño resecados en forma incidental durante la realización de otros procedimientos quirúrgicos. El tercer y cuarto caso son pacientes que consultaron con sensación de pesadez en el hipocondrio derecho en los cuales el estudio realizado con ECO, TAC, RNM y cintigrafía hepática plantearon el diagnóstico de hiperplasia nodular. En la lesión de mayor tamaño se realizó biopsia incisional que confirmó el diagnóstico. Se destaca que son lesiones poco frecuentes, generalmente asistomáticas y con escasa o nula tendencia a producir complicaciones, por lo cual su manejo es conservador, salvo en lesiones muy sintomáticas o de fácil resolución quirúrgica durante hallazgo incidental