Combined treatment of focal nodular hyperplasia with superselective transarterial embolization and sequential microwave ablation: A case report

Focal nodular hyperplasia (FNH) is a benign liver lesion that typically does not require treatment unless it becomes symptomatic or shows progressive enlargement. We present a case of a 28-year-old woman with a history of infertility on long-term hormonal therapy who was found to have progressive enlargement of a pre-existing FNH lesion associated with nonspecific right-upper-quadrant pain. Repeat multiphasic imaging confirmed interval growth. A 2-step minimally invasive strategy was employed: superselective transarterial embolization (TAE) using polyvinyl alcohol particles, followed by microwave ablation (MWA) to ensure complete devascularization and ablation of the lesion. This combined approach resulted in full resolution of symptoms and significant lesion shrinkage, with no complications. The patient remained stable on follow-up imaging. This case suggests that combined TAE followed by MWA can be considered in symptomatic FNH as a minimally invasive treatment option for patients with reproductive considerations.