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Monday, 18 April 2022

CASE 629:Huge focal nodular hyperplasia presenting in a 7-year-old child: Dr Phan Thanh Hai, Dr Nguyen Duc Duy Linh, Dr Nguyen Ngoc Xuan Giang , MEDIC BÌNH AN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A healthy 7-year-old boy on imaging examinations, including abdominal ultrasound and computed tomography (CT):


An abdominal ultrasound scan revealed a 5.3 × 5.2 cm lesion which was homogeneous  hypoechoic solid mass and its central scar in the right lobe of the liver. It existed Doppler signals of central feeding artery in the mass on a fatty infiltrated  of parenchyma of liver.

On CT  of abdomen, NECT showed a 5.7 × 5.4 cm hyperdense  mass in comparison to normal liver in the right hepatic lobe, which displayed a central star-like scar in the low-density area. On the contrast CT scan (CECT) transient, intense, and homogeneous enhancement in the hepatic arterial phase and hyperdense to normal liver in the venous phase. In the delayed phase, mass was  in hyperdense to liver while central scar was in hypodense density.

Laboratory testing revealed the following: alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were 30.1 U/L (normal, 3–30 U/L) and 32.3 U/L (normal, 6–25 U/L), respectively; viral serologic tests for hepatitis B and C were negative; the alpha-fetoprotein (AFP) level was 1.6 ng/mL; and the carbohydrate antigen 19-9 (CA 19-9) level was 7.03 U/mL.


Primary tumors of the liver, including malignant and benign tumors, constitute 1%–2% of all pediatric tumors. Focal nodular hyperplasia (FNH) is a benign lesion of the liver which is usually found in healthy adults. However, FNH is rare in children, and comprises only 2% of all pediatric liver tumors. It is occasional for children suffering from FNH without symptoms. We usually use some imaging modalities (ultrasound and CT scan) to ensure the diagnosis and follow-up the FNH of liver.





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