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Focal Nodular Hyperplasia of the Liver

Last updated May 26, 2018

Approved by: Krish Tangella MD, MBA, FCAP

Focal Nodular Hyperplasia (FNH) of the Liver is a condition that results in a benign tumor growth in the liver.


What are the other Names for this Condition? (Also known as/Synonyms)

  • Benign Nodule of Liver (Focal Nodular Hyperplasia of the Liver)
  • FNH (Focal Nodular Hyperplasia) of the Liver
  • Hepatoptosis

What is Focal Nodular Hyperplasia of the Liver? (Definition/Background Information)

  • Focal Nodular Hyperplasia (FNH) of the Liver is a condition that results in a benign tumor growth in the liver
  • FNH typically occurs in young women, between the ages of 20 and 30 years. This is likely, due to the fact that FNH is associated with reproductive hormones, and women between these ages characteristically have large fluctuations, in their reproductive hormonal levels
  • Most tumors associated with the condition do not cause any symptoms; they may only become incidentally apparent, during a physical examination or through imaging studies
  • Since, no symptoms are present and FNH tumors are benign in nature, they rarely require any treatment

Who gets Focal Nodular Hyperplasia of the Liver? (Age and Sex Distribution)

  • Focal Nodular Hyperplasia of the Liver, most commonly occurs in young adult women, between 20 and 30 years of age
  • Infrequently, men are also known to develop this condition

What are the Risk Factors for Focal Nodular Hyperplasia of the Liver? (Predisposing Factors)

Common risk factors of Focal Nodular Hyperplasia of the Liver include:

  • Sex: Females, especially young adults, have a higher risk
  • Presence of congenital abnormalities in liver blood vessels
  • Smoking
  • Having an unbalanced diet, low in grains and vegetables
  • Abnormal reproductive hormone levels can increase the risk

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Focal Nodular Hyperplasia of the Liver? (Etiology)

  • Focal Nodular Hyperplasia of the Liver is believed to be caused by congenital abnormalities in the liver blood vessels. Individuals, with such anomalies, have abnormal liver blood vessels from birth
  • A presence of these ‘FNH-causing’ congenital abnormalities may cause some liver cells, to receive more blood, nutrients, and oxygen, than other cells. This causes them to grow into a tumor-like mass that are generally noticeable, when individuals are between 20-30 years of age
  • Some researchers also consider that certain hormones may be involved in causing the liver condition. Reproductive hormones are believed to cause FNH tumors to grow larger

What are the Signs and Symptoms of Focal Nodular Hyperplasia of the Liver?

Signs and symptoms of Focal Nodular Hyperplasia of the Liver include:

  • Presence of tumor growth during physical exam in the liver; visible tumor during imaging procedures
  • Occasional abdominal pain
  • Feeling of fullness, bloating (rare)
  • Bleeding into the abdomen (observed in rare cases)

How is Focal Nodular Hyperplasia of the Liver Diagnosed?

A diagnosis of Focal Nodular Hyperplasia of the Liver may involve:

  • Physical exam: Most FNH cases may be diagnosed, via a physical examination. If the physician notes any stiffness or hardness, when pressing upon the liver; then, a mass such as FNH is suspected. Furthermore, gathering information on the individual’s health and personal habits, serves as a good indicator to their risk of developing this benign liver tumor. If the risks are evident, then the physician may suspect Focal Nodular Hyperplasia
  • Imaging studies: Such studies can confirm a healthcare provider’s diagnosis. Using radiological tests, such as CT scan of the abdomen, MRI scan of abdomen, and abdominal ultrasound, the presence of a liver tumor can be imaged
  • When, neither a physical examination nor an imaging study, can confirm the diagnosis of Focal Nodular Hyperplasia of the Liver, a biopsy may be conducted. During a biopsy, a sample of tissue from the suspected hepatic tumor is collected and sent for examination, to a laboratory. A pathologist studies the specimen under a microscope, in order to make a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Focal Nodular Hyperplasia of the Liver?

Complications due to Focal Nodular Hyperplasia of the Liver are generally rare.

  • However, an excessive tumor growth and its subsequent rupturing may result in an internal bleeding. This usually requires urgent medical attention

How is Focal Nodular Hyperplasia of the Liver Treated?

Treatment of Focal Nodular Hyperplasia of the Liver is typically planned on a case-by-case basis.

  • If the healthcare provider believes that the tumor is asymptomatic and does not pose a major health risk, they will often recommend that FNH be closely monitored, instead of a removal. In such cases, it is important to frequently follow-up with the physician and to also ensure that regular liver imaging is done, in order that the FNH growth is monitored and any change in its size observed
  • On the other hand, some physicians may recommend the surgical removal of Focal Nodular Hyperplasia of the Liver. They usually recommend a surgery, if the tumor is symptomatic and poses a risk of developing into a cancer
  • The individual may be advised to stop the use of oral contraceptives and hormone replacement medications, if they have FNH. Hormones are believed to cause tumors to grow larger, which increases their risk of rupture, leading to an internal bleeding

How can Focal Nodular Hyperplasia of the Liver be Prevented?

  • Focal Nodular Hyperplasia of the Liver is thought to be caused by congenital blood vessel abnormalities of the liver. Since these abnormalities are present from birth, there are no preventative methods against FNH of the Liver
  • It is however possible, to take some measures to reduce one’s risk of developing FNH
    • It is recommended that you do not use hormone replacement medications (hormonal replacement treatment - HRT)
    • It is also recommended that you consult a healthcare provider before planning a pregnancy, if you have other risk factors associated with FNH. A pregnancy may elevate many hormone levels, which may cause growth of a liver tumor

What is the Prognosis of Focal Nodular Hyperplasia of the Liver? (Outcomes/Resolutions)

  • Individuals with Focal Nodular Hyperplasia of the Liver, generally have an excellent prognosis
  • FNH tumors are benign, which implies that they usually do not develop into cancer. Besides, since most of them are frequently asymptomatic, surgery is rarely required

Additional and Relevant Useful Information for Focal Nodular Hyperplasia of the Liver:

Liver needle biopsy is conducted to sample abnormal liver tissue, which is then examined to detect the presence of abnormalities. The following article link will help you understand the surgical procedure.

https://www.dovemed.com/common-procedures/procedures-surgical/liver-needle-biopsy/

What are some Useful Resources for Additional Information?


References and Information Sources used for the Article:


Helpful Peer-Reviewed Medical Articles:


Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: May 26, 2014
Last updated: May 26, 2018