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nodular regenerative hyperplasia of the liver

Thursday 29 May 2003

Definition: Nodular regenerative hyperplasia of the liver is defined by hepatocellular nodules distributed throughout the liver in the absence of fibrous septa between the nodules.

Nodular regenerative hyperplasia is a secondary and nonspecific tissue adaptation to heterogeneous distribution of blood flow and does not represent a specific entity. Approximately 50% of these patients develop portal hypertension.

Synopsis

- characterized grossly by diffusely nodular liver resembling micronodular cirrhosis.
- regenerative parenchyma without fibrosis, usually smaller than the hepatic lobule.

Variants

- hepatic diffuse nodular hyperplasia in cirrhosis
- possible familial occurrence

Associations

- Budd-Chiari syndrome
- congenital absence of portal vein
- sickle cell anemia
- hepatocellular carcinoma (HCC)
- celiac disease
- dysimmunity

  • polyarteritis nodosa
  • rheumatoid arthritis
  • collagen vascular diseases (collagen diseases)
  • Sjogren syndrome
  • Schnitzler syndrome (urticaria, macroglobulinemia, sclerotic bone lesions)
  • systemic lupus erythematosus
  • antiphospholipid antibodies syndrome (antiphospholipid antibodies)
  • systemic sclerosis
  • Felty syndrome

- 6-thioguanine therapy
- anticonvulsant drug therapy
- Donohue syndrome
- disseminated intravascular coagulation
- angiomyolipoma of the kidney
- renal allograft
- azathioprine
- hepatotoxic drugs
- hematological malignancies

  • lymphoproliferative disorders
  • myeloproliferative disorders

- sarcoidosis

Differential diagnosis

- other nodular lesions of the liver

See also

- nodular transformation of the liver

  • focal nodular hyperplasia
  • partial nodular transformation
  • cirrhosis telangiectasia hepatis
  • nodular regenerative hyperplasia

References

- Wanless IR. Micronodular transformation (nodular regenerative hyperplasia) of the liver: a report of 64 cases among 2,500 autopsies and a new classification of benign hepatocellular nodules. Hepatology. 1990 May;11(5):787-97. PMID: 2189821