Nodular regenerative hyperplasia

BUSULFAN TIOGUANINE t risk of nodular regenerative hyperplasia of the liver, oesophageal varices and portal hypertension Mechanism uncertain Monitor liver function and for clinical and biochemical indices of liver toxicity (e.g. ascites, splenomegaly). Ask patients to report any symptoms suggestive of oesophageal bleeding... 

Nodular regenerative hyperplasia (see chapter 36.4.3) is also deemed to be a benign hyperechoic structural deficiency. These multiple foci resemble grapes in their appearance and are found in the direct vicinity of vessels, possibly causing portal hypertension. Foci are 1-3 cm in size and may easily be confused with metastases. 

Cano-Rnlz, A., Martin-Scapa, MA., Larraona, J.L., Gonzales-Martin, J.A., Moreno-Caparros, A., Garcia-Plaza, A. Laparoscopic findings in seven patients with nodular regenerative hyperplasia of the hver. Amer. J. Gastroenterol. 1985 80 796—800... 

Both liver adenomas and nodular regenerative hyperplasia can cause a presinusoidal block due to distortion of the portal veins. Wilson s disease leads to an overlapping of presinusoidal and sinusoidal portal hypertension. In alcoholic cirrhosis, there is an overlap of the sinusoidal and postsinusoidal forms. 

Naber, A.H.J., van Haelsf, U, Yap, S.H Nodular regenerative hyperplasia of the liver an important cause of portal hypertension in noncirrhotic patients. J. Hepatol. 1991 12 94-99... 

Strohmeyer, F.W., Ishak, K.G. Nodular transformation (nodular regenerative hyperplasia) of the liver A clinicopathologic study of 30 cases. Human Pathol 1981 12 60-71... 

Wanless, I.R. Micronodular transformation (nodular regenerative hyperplasia) of the hver a report of 64 cases among 2500 autopsies and a new classification of benign hepatocellular nodules. Hepatology 1990 11 787-797... 

Similarly, in various liver diseases, thought should be given to the presence of HE if neuropsychiatric disturbances occur. This is true for acute liver diseases (severe acute viral hepatitis, acute liver failure) and for severe (particularly alcohol-related) fatty liver, Wilson s disease, severe chronic hepatitis, severe infectious or parasitic liver diseases such as schistosomiasis, metastatic liver, nodular regenerative hyperplasia, and liver cirrhosis. (1,16,17, 22, 24,28,29, 67,76,78,95,104) The diagnosis of HE can prove difficult if the liver disease is (still) unknown. 

A particular hepatotropicity causing severe herpes hepatitis is ascribed to herpesvirus 6 (HHV-6). There have even been reports of a fulminant course with this virus infection. (18, 23, 35) HHV-8 causes Kaposi s sarcoma. The liver is the most common site, with dark reddish-violet tumour nodes. Histological analysis reveals endothelial cell proliferations and growths of spindle-shaped fibroblast-like cells. The bile ducts may be altered. Transaminase levels are elevated, and jaundice occurs. There may be a causal relationship between HHV-8 infection and multicentric Castlemans disease. The latter usually implies the presence of peliosis hepatis, perisi-nusoidal fibrosis and nodular regenerative hyperplasia. 

Beer, T.W., Carr, N.J., Buxton, P.J. Thorotrast-associated nodular regenerative hyperplasia of the liver. J. Clin. Pathol. 1998 51 941 -942... 

Focal nodular hyperplasia (FNH) Nodular regenerative hyperplasia (NRH) Regenerative nodes... 

The first description was given in 1953 by S. Ranstrom, who called this condition miliary hepatocellular adenomatosis . The term nodular regenerative hyperplasia (NRH) was introduced by RE. Steiner in 1959. 

Austin, A., Campbell, E., Lane, R, Hias, E. Nodular regenerative hyperplasia of the liver and celiac disease potential role of IgA antic-ardiolipin antibody. Gut 2004 53 1032-1034... 

Colina, R, Pinedo, R, Solis, J.A., Moreno, D., Nevado, M. Nodular regenerative hyperplasia of the liver in early histological stages of primary biliary cirrhosis. Gastroenterology 1992 102 1319-1324... 

K. G. Nodular regenerative hyperplasia of the liver clinical and radio-logic observations. Amer. J. Roentgenol. 1987 148 717-722... 

Dumortier, J., Boillot, O., Chevallier, M., Berger, F., Potier, R, Valette, P.J., Paliard, R, Scoazec, J.Y. Familial occurrence of nodular regenerative hyperplasia of the liver a report on three families. Gut 1999 45 289-294... 

Nakamura, Y. Nodular regenerative hyperplasia of the liver retrospective survey in autopsy series. J. Clin. Gastroenterol. 1990 12 460-465... 

Trauner, M., Stepan, K.M., Resch, M., Ebner, F., Pristautz, H., Klimp-finger, M. Diagnostic problems in nodular regenerative hyperplasia (nodular transformation) of the liver. Review of the literature and report of two cases. Z. Gastroenterol. 1992 30 187-194... 

Malamut, G., Perlemuter, G., Buffet, C., Bedossa, P., Joly, J.P., Colombat, M., Enoch, V., Pelletier, G. Epithelioid hemangioendothelioma in a patient with nodular regenerative hyperplasia. Gastroenterol. Clin. Biol. 2001 25 1105-1107... 

Felty s syndrome (A.R. Felty, 1924) is a special form of seropositive polyarthritis. It leads to considerable changes in the articular structures. Characteristic findings include splenomegaly, leucopenia, lymphadenopathy and skin pigmentation. Men are mainly affected. The liver is involved in about 70% of patients. Transaminases and y-GT values are moderately elevated, and there is an occasional rise in alkaline phosphatase. Lymphocytic infiltrates of the sinusoids, proliferation of Kupffer cells and periportal fibrosis are detectable histologically. Nodular regenerative hyperplasia can develop, which may subsequently cause portal hypertension and macronodular cirrhosis. (71, 95, 104)... 

Blendis, LJM., Lovell, D., Barnes, C.G., Ritland, S., Cattan, D. Oesophageal variceal bleeding in Felty s syndrome associated with nodular regenerative hyperplasia. Ann. Rheum. Dis. 1978 37 183—186... 

Delayed portal blood flow Congenital fibrosis Liver cirrhosis Lymphoma Nodular regenerative hyperplasia Retroperitoneal fibrosis Stenoses/strictures ... 

Nodular regenerative hyperplasia Non-steroidal antirheumatics 5 -Nucleotidase... 

Other histological features that have been described include lesions of the hepatic venous system (pehosis hepatis, sinusoidal dilatation, perivenous fibrosis, and nodular regenerative hyperplasia) and these can be associated with portal hypertension (SEDA-16,520) (SED-13, 1120) (21). Particularly severe and potentially fatal veno-occlusive liver disease has been reported in patients with renal and allogeneic bone marrow transplants taking chronic treatment (26) (SEDA-12, 386), but complete histological reversal can be observed (SEDA-20, 341). 

There has also been a report of nodular regenerative hyperplasia of the Uver associated with previous Thorotrast administration (5). 

Beer TW, Carr NJ, Buxton PJ. Thorotrast associated nodular regenerative hyperplasia of the hver. J Clin Pathol 1998 51(12) 941-2. 

Among 111 patients taking tioguanine for inflammatory bowel disease, 29 had laboratory abnormalities, most commonly rises in liver enzjmes and reduced platelet counts (1). Of the patients who underwent Uver biopsy, there was nodular regenerative hyperplasia in 76% of those with laboratory abnormalities and 33% of those without. 

Nodular regenerative hyperplasia of the liver has been reported in three patients with inflammatory bowel disease who had taken tioguanine for more than a year and who had raised serum liver enzymes all three had histological foci of nodular regenerative hyperplasia, which was best seen with reticulin silver impregnation (4). 

A 51-year-old man, with a 9-year history of renal insufficiency and an alcohol intake of 4 U/week, underwent transplant nephrectomy. At surgery, ascites and liver cirrhosis were noted. A needle biopsy of the liver 1 month later showed nodular regenerative hyperplasia but no cirrhosis. There were subendothehal vacuolated cells, suggestive of modified stellate cells, and there was adjacent focal perisinusoidal fibrosis. His medications included one multivitamin/mineral supplement per day containing vitamin A 4000 lU. His vitamin A concentration was 1045 (reference range 490-720) ng/ml. Viral and antibody studies were negative. 

Bioulac-Sage P, Dubuisson L, Bedin C, et al. 1992. Nodular regenerative hyperplasia in the rat induced by a selenium-enriched diet Study of a model. Hepatology 16(2) 418-425. 

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