International Journal of Hematology and Oncology
2023, Vol 33, Num 4 Page(s): 112-117
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Hepatic Focal Nodular Hyperplasia Developing after Childhood Cancers: Two-Center’s Experience from Turkey
Deniz TUGCU1, Rejin KEBUDI2, Ferhan AKICI1, Ensar YEKELER3, Metin DEMIRKAYA4, Gonul AYDOGAN1, Zafer SALCIOGLU1, Arzu AKCAY1, Hulya S. SEN1, Omer GORGUN2
1Kanuni Sultan Süleyman Education and Research Hospital, Department of Pediatric Hematology and Oncology, Istanbul, TURKEY
2Istanbul University, Oncology Institute, Department of Pediatric Hematology and Oncology, Istanbul, TURKEY
3Istanbul University, Istanbul Medical School, Division of Radiology, Istanbul, TURKEY
4Uludag University, Uludag Medical School, Department of Pediatric Oncology, Bursa, TURKEY
Keywords: Focal nodular hyperplasia, Pediatric cancer, Liver
Even though Focal nodular hyperplasia (FNH) is a rare lesion of the liver in children, it is reported at increased rates in treated pediatric cancer patients. The aim of this retrospective study is to describe the clinical and radiological characteristics and clinical course of patients diagnosed as FNH after primary malignancy in childhood. We retrospectively evaluated the diagnostic work-up, radiologic findings, clinical course and outcome of 8 patients, diagnosed as FNH after pediatric cancer treatment at the Department of Pediatric Hematology- Oncology of the Kanuni Sultan Suleyman Training and Research Hospital and Istanbul University, Oncology Institute, between 1993 and 2011. FNH lesions were diagnosed in 8 of 1600 solid tumors (0.5%) after a median interval of 8 (2-18) years, from the termination of the antineoplastic therapy for the primary cancer. Five patients had a history of neuroblastoma and two patients had rhabdomyosarcoma and one of them had primitive neuroectodermal tumor. FNH was incidentally found at USG or MRI performed during routine follow-up. Two children underwent surgical biopsies to rule out liver metastases. The lesions were stable for a median of 12 months (3-108 months) followup, no malign transformation was detected. FNH may be encountered as a radiological finding during follow-up in pediatric malignancies without hematopoetic stem cell transplantation and may be misdiagnosed as liver metastasis. FNH should be considered in the differential diagnosis of liver lesions encountered during follow up children with cancer. After the diagnosis of these benign lesions radiologically without biopsy, close imaging follow-up is recommended.
Deniz TUGCU1, Rejin KEBUDI2, Ferhan AKICI1, Ensar YEKELER3, Metin DEMIRKAYA4, Gonul AYDOGAN1, Zafer SALCIOGLU1, Arzu AKCAY1, Hulya S. SEN1, Omer GORGUN2
1Kanuni Sultan Süleyman Education and Research Hospital, Department of Pediatric Hematology and Oncology, Istanbul, TURKEY
2Istanbul University, Oncology Institute, Department of Pediatric Hematology and Oncology, Istanbul, TURKEY
3Istanbul University, Istanbul Medical School, Division of Radiology, Istanbul, TURKEY
4Uludag University, Uludag Medical School, Department of Pediatric Oncology, Bursa, TURKEY
Keywords: Focal nodular hyperplasia, Pediatric cancer, Liver
Even though Focal nodular hyperplasia (FNH) is a rare lesion of the liver in children, it is reported at increased rates in treated pediatric cancer patients. The aim of this retrospective study is to describe the clinical and radiological characteristics and clinical course of patients diagnosed as FNH after primary malignancy in childhood. We retrospectively evaluated the diagnostic work-up, radiologic findings, clinical course and outcome of 8 patients, diagnosed as FNH after pediatric cancer treatment at the Department of Pediatric Hematology- Oncology of the Kanuni Sultan Suleyman Training and Research Hospital and Istanbul University, Oncology Institute, between 1993 and 2011. FNH lesions were diagnosed in 8 of 1600 solid tumors (0.5%) after a median interval of 8 (2-18) years, from the termination of the antineoplastic therapy for the primary cancer. Five patients had a history of neuroblastoma and two patients had rhabdomyosarcoma and one of them had primitive neuroectodermal tumor. FNH was incidentally found at USG or MRI performed during routine follow-up. Two children underwent surgical biopsies to rule out liver metastases. The lesions were stable for a median of 12 months (3-108 months) followup, no malign transformation was detected. FNH may be encountered as a radiological finding during follow-up in pediatric malignancies without hematopoetic stem cell transplantation and may be misdiagnosed as liver metastasis. FNH should be considered in the differential diagnosis of liver lesions encountered during follow up children with cancer. After the diagnosis of these benign lesions radiologically without biopsy, close imaging follow-up is recommended.
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