Chapter 18: LIVER: NODULAR HYPERPLASIAS Flashcards
Hepatic masses may come to attention for a variety of reasons.
What could these reasons be?
They may generate epigastric fullness and discomfort or be detected by routine physical examination or radiographic studies
for other indications.
Nodular hyperplasias are not neoplasms; the remaining lesions discussed
in this section are true neoplasms.
What are NODULAR HYPERPLASIAS?
Solitary or multiple hyperplastic hepatocellular nodules may develop in the noncirrhotic liver.
In Nodular hyperplasia of the liver, what are the two such conditions, having confusingly overlapping names?
- focal nodular hyperplasia and
- nodular regenerative hyperplasia.
What is the common factor in two such conditions of Nodular hyperplasia of the liver?
The common factor in both types of nodules seems to be
either focal or diffuse alterations in hepatic blood supply,arising fromobliteration of portal vein
radicles and compensatory augmentation of arterial blood supply.
What is the appearance of Focal nodular hyperplasia?
appears as a well-demarcated but poorly
encapsulated nodule, ranging up to many centimeters in diameter ( Fig. 18-43A ).
The lesion is generally lighter than the surrounding liver and is sometimes yellow.
Typically, there is a central gray-white, depressed stellate scar from which fibrous septa radiate to the periphery ( Fig. 18-43B ).
The central scar contains large
vessels, usually arterial, that typically show fibromuscular hyperplasia with eccentric or
concentric narrowing of the lumen.
The radiating septa show foci of intense lymphocytic
infiltrates and exuberant bile duct proliferation along septal margins.
The parenchyma
between the septa shows essentially normal hepatocytes but with a thickened plate
architecture characteristic of regeneration.
What is the clinical course of Focal nodular hyperplasia?
It presents as a spontaneous mass lesion in an otherwise normal liver, most frequently in young to
middle-aged adults.
What is implicatede in the development of focal nodular hyperplasia?
- *Long-term use of anabolic hormones** or of
- *contraceptives** have been implicated in the development of focal nodular hyperplasia.
What is the gross appearance of Nodular regenerative hyperplasia?
denotes a liver entirely transformed into roughly
spherical nodules, in theabsence of fibrosis.
What is the microscopic appearance of Nodular regenerative hyperplasia?
Microscopically, plump hepatocytes are
surrounded by rims of atrophic hepatocytes.
The variation in parenchymal architecture may
be missed on an H&E stain, and reticulin staining is required to appreciate the changes in
hepatocellular architecture.
Nodular regenerative hyperplasia can lead to the development of what?
portal hypertension and occurs in association with conditions affecting intrahepatic blood
flow, including solid-organ (particularly renal) transplantation, bone marrow transplantation,
and vasculitis.
It also occurs in HIV-infected persons
FIGURE 18-43 Focal nodular hyperplasia.
A, Resected specimen showing lobulated
contours and a central stellate scar.
B, Low-power photomicrograph showing a broad
fibrous scar with hepatic arterial and bile duct elements and chronic inflammation, present
within hepatic parenchyma that lacks the normal sinusoidal plate architecture.
END
NODULAR HYPERPLASIAS
