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RESIDENT
CASE
STUDIES
August 21,
2003: Case 3 Table
of Contents | List
of Diagnoses | Case 1 | Case 2 | Case
3 | Case 4 46 year old female with mass in right hepatic lobe
Discussion by Karen Cline, DO
- Focal nodular hyperplasia
is characterized by hyperplastic hepatocytes subdivided into nodules by fibrous septa containing thick-walled arteries, inflammatory infiltrate, and bile ductule proliferation.
Distribution: Females in 3rd-4th decade
Gross Appearance: Single, subcapsular, unencapsulated
yet well circumscribed nodule with a tan-nodular cut surface with central stellate scar. No gross bile staining.
Microscopic
Appearance:
- Individual nodules of
hepatocytes, 1-2 cells thick, that lack central veins and portal
tracts and are surrounded by fibrous septa with variable numbers of
small proliferating bile ductules.
- Well developed reticular framework with inflammatory infiltrate and large arteries.
Diagnostic
Criteria:
- Nodular architecture
- Fibrous septa with thick-walled vessels
- Proliferation of bile ductules
Differential Diagnosis:
- Hepatocellular adenoma: Lacks fibrous septa
and proliferating bile ductules
- Fibrolamellar hepatocellular carcinoma: gross bile staining, pleomorphic
and oncocytic hepatocyes, and lamellar fibrosis
- Nodular regenerative hyperplasia: hepatocytes vary in size,
lack fibrous septa with proliferating bile ductules and large vessels
- Macroregenerative nodules: usually multiple and <1.5cm
References:
- Cotran: Robbins Pathologic Basis of
Disease, 6th ed. 1999 W. B. Saunders Company.
- Stephen
S Sternberg et al. (Eds): Diagnostic surgical pathology, Volume 1, 3rd
edition. Lippincott William& Wilkins.
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