Korean J Gastroenterol.  2015 Jan;65(1):52-56. 10.4166/kjg.2015.65.1.52.

A Case of Nodular Regenerative Hyperplasia of the Liver Combined with Toxic Hepatitis

• Jin SM
• Song SH
• Cho YH
• Shin DK
• Shin SY
• Kim GI
• Park H
• Rim KS

• KMID: 2373181
• DOI: http://doi.org/10.4166/kjg.2015.65.1.52

Abstract

Nodular regenerative hyperplasia (NRH) is an uncommon liver condition characterized by diffuse transformation of the hepatic parenchyma into regenerative nodules without fibrosis. Portal vasculopathy caused by abnormal hepatic venous flow may induce hepatocyte hyperplasia, which forms regenerative nodules. Underlying diseases or certain drugs may also be the cause of NRH. This condition is often underdiagnosed as the patients remain asymptomatic until development of portal hypertension, and histopathologic confirmation by liver biopsy is the only way of making a definite diagnosis. The management mainly involves prevention and treatment of the complications of portal hypertension. The frequency of diagnosis of NRH has increased rapidly in recent years, however, only a few cases have been reported in Korea. Here, we report on a case of NRH of the liver combined with toxic hepatitis.

Keyword

Nodular regenerative hyperplasia; Drug-induced liver injury; Liver diseases

MeSH Terms

Alanine Transaminase/analysis
Aspartate Aminotransferases/analysis
Bilirubin/blood
Chemical and Drug Induced Liver Injury/complications/*diagnosis/pathology
Duodenal Ulcer/pathology
Endoscopy, Digestive System
Female
Focal Nodular Hyperplasia/complications/*diagnosis/pathology
Humans
Liver/enzymology/pathology
Magnetic Resonance Imaging
Middle Aged
Tomography, X-Ray Computed
Aspartate Aminotransferases
Alanine Transaminase
Bilirubin

Figure

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  Fig. 1. Abdominal CT shows uneven hepatic nodular lesions with decreased enhancement at portal phase (A) and moderate amount of ascites at pre-contrast phase (B).

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  Fig. 2. Initial liver MRI shows large T2 low (A) and T1 high (B) nodular lesions in the liver.

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  Fig. 3. (A) Most hepatocytes are arranged in two-to-three cell thick plates, and small cell or large cell changes (arrowheads) are seen (H&E, ×100).(B) Masson trichrome stain (×40) shows absence of fibrosis and presence of portal tracts (arrows).

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  Fig. 4. Follow-up liver MRI shows progression of nodular regenerative hyperplasia in the liver. These nodular lesions show T2 low (A) and T1 high (B) signal intensity.

Reference

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