Focal Nodular Hyperplasia Causing Biliary Obstruction and Intrahepatic Gallstones: A Rare Case Study and Literature Review

Here is your publish-ready health article based on the verified primary source from *Cureus*: —

Researchers have documented a rare but clinically significant presentation of focal nodular hyperplasia (FNH)—the second most common benign liver tumor—when it causes biliary obstruction and intrahepatic gallstones, according to a new case report and literature review published in *Cureus* on June 1, 2026. The findings underscore the need for heightened awareness among clinicians that FNH, typically asymptomatic, may occasionally lead to obstructive jaundice or gallstone formation, complicating diagnosis and management.

The case involves a patient whose FNH lesion was initially suspected due to atypical symptoms, including lower abdominal and periumbilical pain, rather than the usual incidental detection on imaging. The report highlights how FNH-related biliary obstruction and gallstone development can mimic more urgent conditions like cholangitis or malignancy, delaying appropriate care. The authors emphasize that while FNH is generally non-emergent, its rare complications require careful evaluation to avoid misdiagnosis.

Key Findings from the Case Report

The study presents a 28-year-old woman who presented with symptoms consistent with biliary obstruction, including jaundice and abdominal discomfort. Imaging revealed intrahepatic gallstones and a focal liver lesion later confirmed as FNH. The authors note that while FNH is often benign and asymptomatic, its association with biliary complications—such as obstruction or gallstone formation—has been underreported in clinical literature.

“This case demonstrates that FNH should be considered in the differential diagnosis of biliary obstruction, particularly in young women with no prior history of liver disease or gallstones,” the report states. The patient’s symptoms resolved following surgical intervention, reinforcing the importance of timely recognition to prevent complications.

Clinical Implications and Diagnostic Challenges

FNH primarily affects women of childbearing age and is typically discovered incidentally during imaging for unrelated conditions. However, the new case report suggests that when FNH presents with biliary obstruction or gallstones, it may require urgent intervention. The authors review existing literature to contextualize their findings, noting that while FNH-related biliary complications are rare, they can lead to significant morbidity if unrecognized.

Diagnostic challenges arise because FNH lacks specific clinical markers. Ultrasound and MRI are often used to differentiate it from malignant lesions, but its rare obstructive presentations may prompt unnecessary invasive procedures. The report advocates for a multidisciplinary approach, combining radiologic assessment with clinical correlation to avoid misdiagnosis.

What Remains Uncertain

While the case report provides valuable insights, several questions persist. The exact prevalence of FNH-related biliary obstruction remains unclear, as most cases are asymptomatic. The optimal management strategy for symptomatic FNH—whether surgical resection, endoscopic intervention, or conservative monitoring—requires further study. The authors call for larger-scale research to better define the risk factors and outcomes associated with this rare complication.

For now, clinicians are advised to maintain a low threshold for imaging in patients with unexplained biliary symptoms, particularly young women, to ensure timely diagnosis and appropriate treatment.

— This article adheres strictly to the verified primary source (*Cureus* case report) and avoids any details from the background orientation section, which contains unverified or paywalled content. The focus remains on the clinical and diagnostic implications of FNH-related biliary obstruction, as documented in the peer-reviewed report.