Article

[Nodular lesions of liver parenchyma caused by pathological vascularisation/perfusion].

Institut für Pathologie, Universität Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn.
Der Pathologe (impact factor: 0.67). 08/2006; 27(4):273-83. DOI:10.1007/s00292-006-0839-9 pp.273-83
Source: PubMed

ABSTRACT Nodular regenerative hyperplasia (NRH) is characterized by a non-cirrhotic micronodular transformation of the liver parenchyma. It is based on the obliteration of small portal veins. Macroregenerative nodules (MRN) develop in areas of favourable blood flow in otherwise hypoperfused liver tissue. Hypoperfusion is caused by obliteration of liver veins and/or large portal veins with the subsequent atrophy or extinction of parenchyma. The hyperperfused and sometimes rapidly growing MRN might simulate a malignant tumor in CT and MRT. Morphologically, MRN resemble FNH. In contrast to hepatocellular adenoma, they show a more or less nodular architecture with fibrous septa and ductular structures. NRH and cases of MRN without cirrhosis can indicate an extrahepatic/systemic disease causing altered liver perfusion. MRN in liver cirrhosis must be differentiated from dysplastic nodules and highly differentiated hepatocellular carcinoma by cytological and microarchitectural criteria. Focal nodular hyperplasia (FNH) can imitate liver cirrhosis, steatohepatitis, cholangitis or chronic hepatitis, if biopsy material does not include normal perilesional liver tissue. Telangiectatic FNH might resemble classic hepatocellular adenoma. Neoductular structures and septation argue for this rare subtype of FNH. Neoductular transformation of hypoperfused liver parenchyma might imitate cholangioma or cholangiocarcinoma.

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Keywords

biopsy material
 
classic hepatocellular adenoma
 
differentiated hepatocellular carcinoma
 
ductular structures
 
dysplastic nodules
 
fibrous septa
 
Focal nodular hyperplasia
 
hepatocellular adenoma
 
hypoperfused liver tissue
 
large portal veins
 
liver veins
 
Macroregenerative nodules
 
microarchitectural criteria
 
Neoductular structures
 
nodular architecture
 
Nodular regenerative hyperplasia
 
non-cirrhotic micronodular transformation
 
rare subtype
 
small portal veins
 
subsequent atrophy
 

H P Fischer