nodular regenerative hyperplasia of the liver

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

• cirrhosis
• partial nodular transformation
• focal nodular hyperplasia
• hepatocellular adenoma (hepatic adenoma)

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