Focal nodular hyperplasia of the liver. A retrospective review of 20 patients managed surgically.

Focal nodular hyperplasia remains a difficult diagnostic and clinical dilemma. Over a 10-year period, 20 patients with this diagnosis underwent surgery in our service. Eight of the patients had focal nodular hyperplasia discovered incidentally as part of investigation or surgery for other unrelated conditions. Seventeen of the patients were female, with 64% receiving oral contraceptives. In the 12 patients without concomitant disease all but one had upper abdominal pain. Despite the use of CT scan, isotope studies, NMR, angiography, ultrasound and biopsy, a firm preoperative diagnosis of focal nodular hyperplasia was made in only one patient. Resective surgery was performed without complication in all cases. During a mean follow-up of 42 months (range 6-128 months) one patient died from lymphoma and two patients had recurrent abdominal pain. This study highlights the difficulty in preoperative diagnosis of focal nodular hyperplasia. Conservative treatment can be considered or resective surgery safely performed for symptomatic or suspect lesions.