Article ; Online: Mild changes of hepatic nodular regenerative hyperplasia may cause portal hypertension and be visible on reticulin but not hematoxylin and eosin staining.
Virchows Archiv : an international journal of pathology
2021 Volume 479, Issue 6, Page(s) 1145–1152
Abstract: Nodular regenerative hyperplasia (NRH) can manifest as alternating parenchymal compression/expansion on hematoxylin and eosin (H&E) staining and as reticulin collapse/nodularity on reticulin staining. Histologic diagnosis can be challenging, especially ... ...
| Abstract | Nodular regenerative hyperplasia (NRH) can manifest as alternating parenchymal compression/expansion on hematoxylin and eosin (H&E) staining and as reticulin collapse/nodularity on reticulin staining. Histologic diagnosis can be challenging, especially when there is mild disease and on limited biopsy samples. We reviewed clinical and histologic parameters in a large series of NRH. We identified 60 liver specimens convincingly showing changes of NRH and reviewed them for clinical (age, sex, symptoms, lab values, portal hypertension [PHTN], NRH etiology) and histologic (inflammation, sinusoidal dilation, cholestasis, architectural change, portal vascular abnormalities, degree of changes on reticulin) parameters. The cases came from 28 women and 32 men (median age: 54 years). Most (55, 92%) were biopsies. Thirty patients were symptomatic. Forty-five cases showed mild NRH changes on reticulin; 24 of these (53%) showed them on H&E as well. Fifteen demonstrated well-developed changes on reticulin, which were always seen on H&E as well. Sinusoidal dilation was commonly observed in both of these subgroups (88% overall). Portal vascular abnormalities were seen in 33%. Well-developed NRH was diffuse more often than mild NRH (53% vs. 4%, P < 0.0001). Twenty-nine patients had clinically confirmed or likely PHTN. Of these, 21 showed mild and 8 showed well-developed NRH changes; only 3 had concomitant advanced fibrosis. Chemotherapy was the most frequent known cause of NRH; 30 patients lacked any definite etiology. NRH can be difficult to diagnose on biopsy, particularly since mild changes may be visible on reticulin but not H&E; even these patients can have PHTN. Additionally, NRH is often idiopathic, potentially lowering clinical and pathologic suspicion. Pathologists should have a low threshold for ordering reticulin stains, especially when a patient is known to have PHTN. Sinusoidal dilation, while nonspecific, commonly accompanies NRH. |
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| MeSH term(s) | Adult ; Aged ; Aged, 80 and over ; Biopsy ; Coloring Agents ; Eosine Yellowish-(YS) ; Female ; Focal Nodular Hyperplasia/complications ; Focal Nodular Hyperplasia/metabolism ; Focal Nodular Hyperplasia/pathology ; Hematoxylin ; Humans ; Hypertension, Portal/diagnosis ; Hypertension, Portal/etiology ; Hypertension, Portal/physiopathology ; Liver/chemistry ; Liver/pathology ; Male ; Middle Aged ; Portal Pressure ; Predictive Value of Tests ; Reticulin/analysis ; Staining and Labeling ; Young Adult |
| Chemical Substances | Coloring Agents ; Reticulin ; Eosine Yellowish-(YS) (TDQ283MPCW) ; Hematoxylin (YKM8PY2Z55) |
| Language | English |
| Publishing date | 2021-08-25 |
| Publishing country | Germany |
| Document type | Comparative Study ; Journal Article |
| ZDB-ID | 1184867-4 |
| ISSN | 1432-2307 ; 0945-6317 |
| ISSN (online) | 1432-2307 |
| ISSN | 0945-6317 |
| DOI | 10.1007/s00428-021-03195-2 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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