Focal Nodular Hyperplasia after Orthotopic Liver Transplantation
SH Ra, CR Lassman. David Geffen School of Medicine at UCLA, Los Angeles, CA
Background: Liver nodules are not uncommonly encountered in the post-transplant liver. The vast majority of these lesions represent hepatocellular carcinoma and infrequently nodular regenerative hyperplasia. Focal nodular hyperplasia (FNH) is a localized hyperplastic overgrowth of hepatocytes typically associated with vascular anomalies. There is scant information in the literature regarding the presence of focal nodular hyperplasia in post- transplant livers. Focal nodular hyperplasia has been well characterized in native livers, but only one case has been described in a transplanted liver.
Design: We review the clinical and pathologic features of 4 patients with the diagnosis of focal nodular hyperplasia after orthotopic liver transplantation.
Results: There were 3 male and 1 female patients, ranging in age from 2-63 years. Two of the patients were originally transplanted for cirrhosis secondary to biliary atresia, one for hepatitis C, and one for hepatitis B&C and alcohol use. The time from transplant to a diagnosis of FNH ranged from 15-118 months. Three patients presented with an incidental solitary liver nodule; one presented with with two liver nodules. All four patients had increases in alkaline phosphatase and one patient had increased ALT and AST. The main considerations before diagnosis were hepatocellular carcinoma and lymphoma. The diagnosis of FNH was made on core needle biopsy in 2 cases, wedge biopsy in 1 case, and at autopsy in 1 case. The nodules ranged in size from 1.7 to 6.9 cm. Three patients had conditions associated with altered vascular perfusion; 2 had portal vein thrombosis and 1 had a partial allograft from a living donor. One patient underwent resection of the FNH; the other 2 patients are being followed clinically.
Conclusions: FNH can present as a hepatic nodule after orthotopic liver transplantation. Due to altered vascular perfusion in the post-transplant livers, we believe that FNH is more common than reported in the literature and should not be confused with hepatocellular carcinoma. FNH should be considered in the differential diagnosis of hepatic nodules within the post-transplant liver, especially in patients with co-existing vascular perfusion abnormalities.
Category: Liver & Pancreas
Tuesday, March 10, 2009 9:30 AM
Poster Session III # 184, Tuesday Morning