Focal nodular hyperplasia coexistent with hemangioma and multiple cysts ofthe liver

We report here a case of hepatic focal nodular hyperplasia (FNH) associated with hepatic hemangioma and multiple hepatic cysts in a 71-year-old man. H e was admitted to our hospital because of body weight loss. Ultrasonography detected multiple cysts, and two tumors in the liver one, 3.5 cm and one, 1.6 cm. Color Doppler ultrasonography showed arterial signals within the la rge tumor. On dynamic computed tomography, the large tumor was a hypodense lesion which was enhanced during the arterial phase and almost isodense dur ing the delayed phase; the small tumor was also a hypodense lesion, and was enhanced during both the arterial and delayed phases. On magnetic resonanc e imaging using superparamagnetic iron oxides, the large tumor had decrease d signal intensity on the T2-weighted image. On hepatic arteriography, the feeding artery of the large tumor showed a spoke-wheel appearance and that of the small tumor showed a cotton-wool appearance. Ultrasonographically gu ided fine-needle aspiration biopsy of the large tumor revealed hepatocellul ar hyperplasia. Finally, we diagnosed the two hepatic tumors as FNH and hem angioma. There was no intracranial lesion. The cause of the patient's emaci ation was psychogenic anorexia. To our knowledge, this is the first case re port that describes the simultaneous occurrence of these three kinds of hep atic lesions. The pathogenesis of FNH still remains unclear, but this assoc iation suggests that FNH may arise because of a vascular anomaly.