Giant focal nodular hyperplasia with atypical imaging due to absent central scar: A case report

Focal nodular hyperplasia (FNH) is widely recognized as one of the leading benign hepatic neoplasms encountered in clinical practice, disproportionately affecting women during their third through fifth decades of life. Although generally asymptomatic, FNH may occasionally present with acute abdominal pain, as illustrated in our case of a young woman with symptomatic giant FNH. Ultrasound, computed tomography, and MRI constitute the main imaging modalities used in the diagnostic evaluation of FNH, each contributing complementary information; however, distinguishing it from malignant hepatic tumors may remain challenging, particularly in atypical presentations. Histopathological examination may therefore be required to establish a definitive diagnosis. Herein we describe the case of a young woman aged 24 years who was referred to our institution following an acute episode of abdominal pain, in whom imaging revealed a large left hepatic lobe FNH with atypical radiological features, notably the absence of a central scar. Histological analysis confirmed the diagnosis. Due to the extrinsic compression effect attributable to the lesion and associated signs of portal hypertension, liver transplantation was considered. This case highlights the importance of recognizing the variable clinical and radiological manifestations of FNH and discusses the diagnostic and therapeutic challenges associated with atypical giant lesions.