Gadoxetic acid, a hepatocyte-specific magnetic resonance imaging (MRI) contrast agent, has emerged as an important tool for hepatocellular carcinoma (HCC) diagnosis. Gadoxetic acid-enhanced MRI is useful for the evaluation of early-stage HCC, diagnosis of HCC precursor lesions, and highly sensitive diagnosis of HCC. Furthermore, functional information provided by gadoxetic acid-enhanced MRI can aid in the characterization of focal liver lesions. For example, whereas lesions lack functioning hepatocytes appear hypointense in the hepatobiliary phase, preserved or enhanced expression of organic anion transporting polypeptides in some HCCs as well as focal nodular hyperplasia lead to hyperintensity in the hepatobiliary phase; and a targetoid appearance on transitional phase or hepatobiliary phase imaging can be helpful for identifying the histopathological composition of tumors. While gadoxetic acid-enhanced MRI may improve the sensitivity of HCC diagnosis and provide new insights into the characterization of focal liver lesions, there are many challenges associated with its use. This article reviews the pros and cons of HCC diagnosis with gadoxetic acid-enhanced MRI and discuss some clues in the radiological differentiation of HCC from HCC mimickers.
Carcinoma, Hepatocellular ; Diagnosis ; Focal Nodular Hyperplasia ; Hepatocytes ; Liver ; Liver Neoplasms ; Magnetic Resonance Imaging ; Peptides

No abstract available.
Focal Nodular Hyperplasia* ; Humans ; Male*

OBJECTIVETo summarize the clinical experience of laparoscopic hepatectomy (LH) for liver tumors in Couinaud Ⅰ, Ⅳa, Ⅶ, and Ⅷ segment.

METHODSFifty-six patients with tumor in Couinaud Ⅰ, Ⅳa, Ⅶ, or Ⅷ segment underwent LH in Department of Hepatobiliary Surgery, the First Affiliated Hospital of Fujian Medical University from July 2009 to December 2014.The pathological diagnoses were hepatic hemangioma(5 patients), colorectal cancer metastasis to the liver(4 patients), hepatic adenoma (6 patients), hepatocellular carcinoma(32 patients), focal nodular hyperplasia(8 patients) and liver harmatoma(1 patient). The liver function of all patients was Child-Pugh class A. All patients were followed up by several kinds of methods which included outpatient or inpatient review, telephone and mail until January 2015.

RESULTSLH was converted to open hepatectomy in one patient, and tumor resection by LH was successful in other patients.The mean diameter of tumor was (5.7±3.4)cm (range 3-9 cm). The mean operative time was (115±46)min (range 55-260 min). And the mean estimated intraoperative blood loss was (181±135)ml (range 20-550 ml). The postoperative hospital stay was (7.1±1.5)days (range 5-10 days). Postoperative complications occurred in 4 patients(7.1 percent) and resolved with conservative management. There was no perioperative deaths. At the 1-month follow-up, 47 patients had returned to full-time work. A total of 9 patients had evidence of recurrence after operation. The one-year overall and disease-free survival rates of patients with malignant tumor were 100 percents and 87.5 percents, respectively.

CONCLUSIONLH for tumors in segment Ⅰ, Ⅳa, Ⅶ, and Ⅷ is safe and effective.

Blood Loss, Surgical ; Carcinoma, Hepatocellular ; surgery ; Disease-Free Survival ; Focal Nodular Hyperplasia ; surgery ; Hemangioma ; surgery ; Hepatectomy ; Humans ; Laparoscopy ; Length of Stay ; Liver Neoplasms ; surgery ; Neoplasm Recurrence, Local ; Operative Time ; Postoperative Complications ; Postoperative Period ; Treatment Outcome

Owing to the progress of imaging techniques, benign hepatocellular nodules are increasingly discovered in the clinical practice. This group of lesions mostly arises in the context of a putatively normal healthy liver and includes either pseudotumoral and tumoral nodules. Focal nodular hyperplasia and hepatocellular adenoma are prototypical examples of these two categories of nodules. In this review we aim to report the main pathological criteria of differential diagnosis between focal nodular hyperplasia and hepatocellular adenoma, which mainly rests upon morphological and phenotypical features. We also emphasize that for a correct diagnosis the clinical context such as sex, age, assumption of oral contraceptives, associated metabolic or vascular disturbances is of paramount importance. While focal nodular hyperplasia is a single entity epidemiologically more frequent than adenoma, the latter is representative of a more heterogeneous group which has been recently and extensively characterized from a clinical, morphological, phenotypical and molecular profile. The use of the liver biopsy in addition to imaging and the clinical context are important diagnostic tools of these lesions. In this review we will survey their systematic pathobiology and propose a diagnostic algorithm helpful to increase the diagnostic accuracy of not dedicated liver pathologists. The differential diagnosis between so-called typical and atypical adenoma and well differentiated hepatocellular carcinoma will also be discussed.
Adenoma/*diagnosis/surgery ; Carcinoma, Hepatocellular/diagnosis ; Diagnosis, Differential ; Focal Nodular Hyperplasia/*diagnosis/surgery ; Hepatocyte Nuclear Factor 1-alpha/metabolism ; Humans ; Liver/pathology ; Liver Neoplasms/*diagnosis/surgery ; beta Catenin/genetics/metabolism

Owing to the progress of imaging techniques, benign hepatocellular nodules are increasingly discovered in the clinical practice. This group of lesions mostly arises in the context of a putatively normal healthy liver and includes either pseudotumoral and tumoral nodules. Focal nodular hyperplasia and hepatocellular adenoma are prototypical examples of these two categories of nodules. In this review we aim to report the main pathological criteria of differential diagnosis between focal nodular hyperplasia and hepatocellular adenoma, which mainly rests upon morphological and phenotypical features. We also emphasize that for a correct diagnosis the clinical context such as sex, age, assumption of oral contraceptives, associated metabolic or vascular disturbances is of paramount importance. While focal nodular hyperplasia is a single entity epidemiologically more frequent than adenoma, the latter is representative of a more heterogeneous group which has been recently and extensively characterized from a clinical, morphological, phenotypical and molecular profile. The use of the liver biopsy in addition to imaging and the clinical context are important diagnostic tools of these lesions. In this review we will survey their systematic pathobiology and propose a diagnostic algorithm helpful to increase the diagnostic accuracy of not dedicated liver pathologists. The differential diagnosis between so-called typical and atypical adenoma and well differentiated hepatocellular carcinoma will also be discussed.
Adenoma/*diagnosis/surgery ; Carcinoma, Hepatocellular/diagnosis ; Diagnosis, Differential ; Focal Nodular Hyperplasia/*diagnosis/surgery ; Hepatocyte Nuclear Factor 1-alpha/metabolism ; Humans ; Liver/pathology ; Liver Neoplasms/*diagnosis/surgery ; beta Catenin/genetics/metabolism

Up-to-date imaging modalities such as three-dimensional dynamic contrast-enhanced CT (3D CT) and MRI may contribute to detection of hypervascular nodules in the liver. Nevertheless, distinguishing a malignancy such as hepatocellular carcinoma from benign hypervascular hyperplastic nodules (HHN) based on the radiological findings is sometimes difficult. Multiple incidental liver masses were detected via abdominal ultrasonography (US) in a 65-year-old male patient. He had no history of alcohol intake and no remarkable past medical history or relevant family history, and his physical examination results and laboratory findings were normal. 3D CT and MRI showed numerous enhanced nodules with hypervascularity during the arterial phase. After US guided liver biopsy, the pathological diagnosis was HHN. To date, several cases of HHN have been reported in patients with chronic alcoholic liver disease or cirrhosis. Herein, we report on a case of HHN in a patient with no history of alcoholic liver disease or cirrhosis.
Abdomen/diagnostic imaging ; Aged ; Alcoholism/pathology ; Chronic Disease ; Diagnosis, Differential ; Focal Nodular Hyperplasia/*diagnosis ; Humans ; Imaging, Three-Dimensional ; Liver/diagnostic imaging/*pathology ; Liver Diseases/pathology ; Magnetic Resonance Imaging ; Male ; Tomography, X-Ray Computed ; Ultrasonography

Nodular regenerative hyperplasia (NRH) is an uncommon liver condition characterized by diffuse transformation of the hepatic parenchyma into regenerative nodules without fibrosis. Portal vasculopathy caused by abnormal hepatic venous flow may induce hepatocyte hyperplasia, which forms regenerative nodules. Underlying diseases or certain drugs may also be the cause of NRH. This condition is often underdiagnosed as the patients remain asymptomatic until development of portal hypertension, and histopathologic confirmation by liver biopsy is the only way of making a definite diagnosis. The management mainly involves prevention and treatment of the complications of portal hypertension. The frequency of diagnosis of NRH has increased rapidly in recent years, however, only a few cases have been reported in Korea. Here, we report on a case of NRH of the liver combined with toxic hepatitis.
Alanine Transaminase/analysis ; Aspartate Aminotransferases/analysis ; Bilirubin/blood ; Chemical and Drug Induced Liver Injury/complications/*diagnosis/pathology ; Duodenal Ulcer/pathology ; Endoscopy, Digestive System ; Female ; Focal Nodular Hyperplasia/complications/*diagnosis/pathology ; Humans ; Liver/enzymology/pathology ; Magnetic Resonance Imaging ; Middle Aged ; Tomography, X-Ray Computed

No abstract available.
Adult ; Female ; Focal Nodular Hyperplasia/*diagnosis/pathology ; Gadolinium DTPA/chemistry ; Hepatitis B, Chronic/diagnosis ; Humans ; Image-Guided Biopsy ; Liver/pathology ; Magnetic Resonance Imaging ; Tomography, X-Ray Computed

Insulinoma, which arises from insulin-producing pancreatic beta cells, is a rare tumor in children. Only 5%-10% of insulinomas are malignant and undergo metastasis. We report a case of an 11-year-old girl who experienced hypoglycemia-related seizures induced by an insulinoma; after resection of the primary tumor, she developed hepatic focal nodular hyperplasia (FNH). Laboratory test results indicated marked hypoglycemia with hyperinsulinemia. Abdominal ultrasonography (US) and computed tomography results were normal; however, magnetic resonance imaging (MRI) showed a solid mass in the pancreatic tail. Therefore, laparoscopic distal pancreatectomy was performed. Two months after the surgery, an abdominal MRI revealed multiple nodular lesions in the liver. An US-guided liver biopsy was then performed, and histological examination revealed FNH without necrosis or mitotic activity. The patient has been free of hypoglycemia for 2 years, and recent MRI studies showed a decrease in the size of FNH lesions, without any evidence of metastasis. Even though no metastatic lesions are noted on imaging, close observation and follow-up imaging studies are required in a child with insulinoma that has malignant potential on histopathologic findings.
Biopsy ; Child* ; Female ; Focal Nodular Hyperplasia ; Humans ; Hyperinsulinism ; Hypoglycemia ; Insulin-Secreting Cells ; Insulinoma* ; Liver* ; Magnetic Resonance Imaging ; Necrosis ; Neoplasm Metastasis* ; Pancreatectomy ; Pediatrics ; Seizures ; Ultrasonography

Focal nodular hyperplasia (FNH) is the second most common benign solid tumor of the liver and is usually found in young females. In FNH, spontaneous bleeding or rupture rarely occurs and malignant transformation is unlikely. The etiology of FNH is unclear, but because of female predominance and young age at onset, it seems that female hormone has an important role for the development of FNH. Although the development and the complications of hepatocellular adenomas have been related to the use of oral contraceptives and pregnancy, the influence of oral contraceptives and pregnancy on the growth and complications of FNH is controversial. Most FNH are stable in size and rarely complicated during pregnancy. We describe here a case of FNH with growth progression during pregnancy in a 27-year-old female. Her course of pregnancy and delivery was uneventful. Two months after delivery, the size of FNH was decreased.
Adult ; Female ; Focal Nodular Hyperplasia/*diagnosis/radiography/ultrasonography ; Humans ; Liver/pathology/radiography ; Pregnancy ; Tomography, X-Ray Computed ; alpha-Fetoproteins/analysis