Diffuse nodular regenerative hyperplasia of the liver (DNRH). A clinicopathologic study of 24 cases

Abstract

ABSTRACT— The authors report 24 cases of diffuse nodular regenerative hyperplasia of the liver (DNRH) seen in a General Hospital during the last 9 years (prevalence: 3'1/100 000, incidence: 0'34/100 000). DNRH was diagnosed in 0.52% of the liver biopsies and 0.72 of the autopsies. These results suggest that DNHR is probably more frequent than suspected, and 1 DNRH was seen for each 39 biopsied cases of liver cirrhosis. Fourteen patients did not have hepatic symptoms. Portal hypertension was present in 9 cases. The biochemical disturbance most frequently found was a moderate elevation of GGT and APh, associated with slight elevation of SGOT, SGPT and bilirubin levels. Normal liver function tests could be seen (3 cases). Previous exposure to potentially hepatotoxic drugs or chemicals was discovered in 15 cases (62.5%). Diseases associated were circulatory disturbances (6 cases), autoimmune disease (5 cases), hemopathies (5 cases), and visceral carcinomas (4 cases). Two patients were recipients of renal transplant. Nodules distributed through the whole liver tissue were found in 16 cases, while 8 patients showed areas of normal parenchyma in their livers. Impairment of small hepatic vessels was detected in 16 cases. Some uneven cytologic findings were discovered: clusters of small basophilic cells (4 cases), large clear cells (8 cases), and dysplastic hepatocytes (10 cases), which suggests that DNRH could be a preneoplastic condition.

Nodular regenerative hyperplasia: The main liver disease in patients with primary hypogammaglobulinemia and hepatic abnormalities

“…Like immunocompetent patients for whom NRH is frequently associated with autoimmune manifestations [11,22,23] 12 of our patients with NRH (75%) had one or several autoimmune diseases with frequent PBL abnormalities (90%). These combined observations suggest that the high frequency of NRH observed in our patients may be explained by an autoimmune mechanism not yet elucidated.…”

Post-transplant liver biopsy and the immune response: lessons for the clinician

“…NRH is a histological diagnosis and comprises of the formation of diffuse regenerative nodules generally smaller than 3 mm accompanied by little or no fibrosis [201]. It has the potential of leading to portal hypertension with variceal bleeding and ascites [202,203]. One of the earliest reports of NRH postliver transplantation described the association with azathioprine therapy [204].…”

Human immunodeficiency virus and nodular regenerative hyperplasia of liver: A systematic review

“…Patients with NRH should be considered for screening for HCC. Although this remains a relatively controversial topic, a possible pathogenetic relationship between NRH and HCC has been described [1,25,[44][45][46][47][48][49][50] . The inability to conclusively establish a propensity of NRH to develop into HCC may be a result of its underestimated incidence, rather than a lack of association between the two conditions.…”