尾状葉に発生しダンベル型を呈した比較的大きな肝 Focal Nodular Hyperplasia の1例

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A 22-year-old women with complaints of diarrhea and vomiting was admitted to our hospital. Her liver tumor was detected by ultrasonography (US) after 2 years' clinical observation. Liver function tests revealed no abnormality except slight elevation of γ-GTP value. US and CT scan demonstrated a dumbbel shaped huge tumor, dimension of 21cm, originated in the caudate lobe. It buldged into the left caudate lobe forming a extrahepatic tumor and into the right lobe. Angiography showed a hypervascular tumor with secondary Budd-Chiari syndrome. Hepatoccellular carcinoma (HCC) was suspected and extended right lobectomy was performed under hypothermal anesthesia. After intraoperative embolization of the feeding artery of the tumor, remarkable dilation of the retroperitoneal lymphatic channels were disappeared. Pathological examination revealed focal nodular hyperplasia (FNH) with a typical central stellate scar.<BR>Differentiation of FNH from HCC in preoperative imaging diagnosis is very difficult even though all kinds of imaging modalities are carried out. However, in patients with a hypervascular tumor and normal liver function tests, FNH should be considered and a series of scintigraphy is proposed.