Focal Nodular Hyperplasia

How to Cite This Chapter: Essaji Y, Krawczyk M, Patkowski W. Focal Nodular Hyperplasia. McMaster Textbook of Internal Medicine. Kraków: Medycyna Praktyczna. Accessed July 18, 2024.
Last Updated: October 13, 2022
Last Reviewed: October 13, 2022
Chapter Information


Focal nodular hyperplasia (FNH) is a noncancerous tumor of the liver. It occurs in 0.3% to 1% of adults, 6 to 8 times more often in women. FNH is generally asymptomatic and found incidentally on imaging. In rare cases it presents with abdominal pain. Extremely large tumors can be palpable through the abdominal wall.


Diagnostic Tests


1) Computed tomography (CT) and ultrasonography: see Table 1 in Hepatic Tumors.

2) Magnetic resonance imaging (MRI) has greater sensitivity in the case of small lesions than CT.

3) CT angiography or sulfur colloid scan could be used in case of diagnostic uncertainty.

Diagnostic Criteria

Diagnosis is based on imaging findings. If in doubt, perform morphologic assessment of the removed tumor.

Differential Diagnosis

Focal lesions in the liver: Hemangioma, adenoma, cyst, hepatocellular carcinoma, metastatic tumors.


1. The vast majority of lesions do not require specific treatment. Perform ultrasonography every 12 months.

2. Indications for surgical treatment: Intraperitoneal hemorrhage or hemorrhage into the tumor, diagnostic uncertainty, rapid tumor enlargement.


Pregnancy and Contraception

The use of combined oral contraceptive pills is considered safe. Pregnancy is not contraindicated, and pregnant women do not require special surveillance.

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