Hepatic focal nodular hyperplasia in children: report of three cases

Hepatic focal nodular hyperplasia is very rare in children. We present 3 cases aged from 8 to 17 years. All of them are girls, none of whom used oral contraceptives. Case 1 was a hepatitis B carrier and was incidentally found to have focal nodular hyperplasia (FNH). The other 2 cases presented with abdominal pain. Abdominal computed tomography revealed a solitary liver tumor in cases 2 and 3, but no abnormalities in case 1. A 7-cm tumor was located in the left lobe of the liver with compression of the stomach in the 2nd case. Abdominal magnetic resonance imaging (MRI) showed a mass with isointense density to liver parenchyma on T1WI and hyperdensity on T2WI in the 1st and the 3rd cases. The inferior vena cava was compressed and displaced anteriorly in the 1st case. Because of differences in the clinical presentation and imaging studies, the 1st and 2nd cases received resection while the 3rd case was treated conservatively. Pathologic findings confirmed the diagnosis of focal nodular hyperplasia in all 3 cases. We emphasize the importance of an MRI scan in the diagnosis of hepatic focal nodular hyperplasia, and different clinical manifestations and imaging studies may lead to different management.