Focal Nodular Hyperplasia of the liver and Diabetes Mellitus
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Background
The focal nodular hyperplasia (FNH) first described by Edmondson in 1956, accounts for 8% of primary hepatic tumors in adults and less than 2% in children. Nonetheless, its evidence in pediatric population is increasing with more than eighty cases described in the last 5 years. The pathogenesis of FNH is largely unknown. Evidences of polyclonality in different DNA studies exclude a neoplastic nature of the lesion and further support the hypothesis of a possible reactive hyperplastic response of liver cells to local vessel abnormality. Chemotherapy and/or radiotherapy may be associated with development of FNH and, as clarified by a case-control study, also smoke may play a pathogenetic role. The association with estroprogestinic therapies is still debated.

Case presentation
A.L., male, suffering from type 1 diabetes mellitus since he was 7 years old; the disease was metabolically compensated with stable insulin doses. At the age of 12 he was admitted for abdominal pain and a voluminous mass in right hypochondria was found; he was in good general conditions (32 kg of weight) and remaining physical examination was normal. His insulin requests were: regular insulin 5 IU before breakfast, 10 IU before lunch and 6 IU before dinner; NPH insulin 16 IU at bedtime. The liver ultrasound scan showed, at the VI liver segment, two hypo-isoechogenous oval lesions whose diameters were, respectively, 83 × 43 mm and 77 × 38 mm. CT scan confirmed the presence of two masses, with an evidence of tumor capsule, that, after contrast injection, were hyperdense in early (arterial) phase and isodense, compared to the remaining liver parenchyma, in venous phase; it also highlighted a central hypodense "scar".....

https://ijponline.biomedcentral.com/articles/10.1186/1824-7288-36-41
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