Nodular Regenerative Hyperplasia: Report of 82 Patients and Systematic Review of Literature

Abstract

BackgroundData about the clinical significance and outcome of patients with nodular regenerative hyperplasia are limited.ObjectiveThe aim of this study was to describe the clinical and histopathological characteristics of patients with nodular regenerative hyperplasia and compare our findings with the literature.MethodsFrom January 2015 to March 2021, patients with a diagnosis of nodular regenerative hyperplasia were included. They were extracted from the database of the pathology department of Cliniques universitaires Saint‐Luc. Clinical and histological data were retrospectively recorded and complications of portal hypertension and mortality were analyzed. We also performed a systematic review of the literature.ResultsEighty‐two histology‐proven nodular regenerative hyperplasia were included. The mean age at diagnosis was 58 ± 14 years. At least one clinical sign of portal hypertension was present in 37 patients (45%), and liver tissue sampling was performed for 29 of them for evaluation of portal hypertension. Conversely, nodular regenerative hyperplasia was an incidental discovery in 27 patients (33%), mostly after liver resection for metastasis (n = 15) or protocol biopsy in liver‐transplanted patients (n = 9). The 5‐year liver‐related mortality was 5%. The 5‐year non‐liver‐related mortality was 20%. Patients diagnosed by clinical suspicion (n = 55) were compared to patients diagnosed incidentally (n = 27). Patients with an incidental diagnosis had more frequently a condition associated with nodular regenerative hyperplasia than patients diagnosed clinically (93% vs. 66%, p = 0.008) and they developed significantly lower liver‐related complications (4% vs. 27%, p = 0.01). A systematic review allowed us to compare our patients with 10 case series in the literature.ConclusionThe clinical spectrum of patients with nodular regenerative hyperplasia is heterogeneous, including patients with clinical liver manifestations and patients diagnosed incidentally who could remain free of liver‐related complications. This suggests that nodular regenerative hyperplasia could be a histological epiphenomenon as well as a clinical entity.