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Nodular regenerative hyperplasia of the liver: an important portal hypertension in non-cirrhotic patients

In our lxnpital

cause of

over the last 10 years a diagnosis of nodular regenerative hyperplasia was made ior II pa!ients.

pcrccnt of thcsc patients had portal hypertension,

representing

cirrhotic

was the second most frequent

liver. Nodular

regenerative b)perplasia

‘lomake the dingnoria.

witbout cirrhov

B rrticulie

stainingof

21% of all our patients with portal hypertension

between malignant disease (multiple

myelora,

chrons

ease). the use of cytotoxic or immunosuppressive nodular regenerstwe

cause of portal hypertension

a surgica! biopsy is most helpful.

tic derangement of the liver architecture on histoloeg may still be overlooked.

symptomat~

,991: 12 94-w Elrevier

However,

Sixty-nine and a nooin patiet +?

the rharaclerir..

In this study a suggestive relation waskond

myelogenous leukaemta. Leydig cell turnour

dn.ga and nodular regenerative hyperplasia.

hyperplasia was observed in patients following

and HcNdgkin’s dis-

Furthermore.

a high tote of

kidney transplantatton.

Liver

ahnormzdnies developed in these patients after a period ranging from 8 month? to 3 years of immunosuppressiveoiothempj.

~ihssr

devrlop in thw

hvcr function abnot’malittes were, howevr,

the treatment ofchotce, for the prevention

lJia:ortton

of rh.: mtrohcpmlc vasculature due to cirrho-

si\ ii the mart common c~ubcof portal hypertension rope and the IJ.S.A.

At

rbis condition,

thr

are usually

in Eu-

histological

evidence of extensive

portal

hypertension

with

oerc ?hagenl vances and ascites may also develop in patient, with B non-cirrhotic

liver. Patntts

clinical evidence of portal hypertension

wth this disorder

Methods The files of all patients with clinical manifestations portal

hypertension

seen in the University

patients with liver biopsies and/or autopsy materiai cating nodular regenerative hyperplasia.

1.1 this paper we rrport

tients with nodular regenerative hyperplasia

on nine patients with nodular re-

byperplana as the cause of portal hypertension

in patwntr wnh a non-cxrhotic

liver. In addition. four pa-

Hospital

of of

Nijmegcn during the last IO years were studied to identify

usually haw normal or nearly normal livct function tests. ;encratwc

are

the complica-

and the development of regenerative rme

tients without presented.

associated with

which indicate paren-

fame

ap-

of recurrent variceal haemorrhage.

ahnormabties

dwuse,

collagen depositloll )wdulo.

Witb

hypertcnrion

certiun biochemxal chymal liver

or che-

usually mild. Since hepatic encephalopathy is not likely to

patients with nodular regenerative hyperplasia a decompressive shunt operation is a good alternative

proach. ifnol

tions of portal

function

lo addition,

indipa-

were Identr-

fied from the files of all patients who had undergone liver

biopsy.

In these eawr, &me stained with hematoxylin-

emin and reticulir

had to be available.

All slides were re-

ReSUltS

viewed and a diagnasis was assigned on the baris of gnerally

accepted

showed: (I)

mtsm.

In

general

the lwer

Diffuse or zonal micronodularny

dence of cirrhosis.

(ii) Compression

hepatocytes in concentric of the nodules.

arrangement

(iii) Occasional

bloprlec

wrhour

and at-ophy

evi-

of the

on the peripher)

sinusoidal dilatations

and

AS aown

m Tnbkr

and five fsnalos.

I and 2. 13 patients (eight male