Nodular Regenerative Hyperplasia

 Typically 1-3 mm



• No fibrous septa between nodules
image But focal sinusoidal or periportal fibrosis can be seen

• Inflammation is absent
image Bile ducts and hepatic arterioles are normal




Top Differential Diagnoses




• Cirrhosis

• Focal nodular hyperplasia

• Adenomatosis

• Partial nodular transformation


Diagnostic Checklist




• Reticulin stain should be obtained in all cases of unexplained portal hypertension

image
Ill-Defined Nodules
Nodular regenerative hyperplasia (NRH) is characterized by diffuse replacement of liver by small nodules image. Nodules are typically 1-3 mm in size but can be as large as 1 cm.


image
Reticulin Stain
Reticulin stain highlights the nodules image. The reticulin network is compressed in the parenchyma between the nodules image. Reticulin stain is very useful for the diagnosis as the nodularity in NRH can be subtle.

image
Trichrome Stain
Trichrome stain highlights the nodules image. By definition, there are no fibrous septa between the nodules in nodular regenerative hyperplasia.

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No Fibrous Septa
Trichrome stain shows absence of fibrous septa at the periphery of the nodules. This distinguished NRH from cirrhosis. Focal sinusoidal dilatation can be seen in NRH image. The hepatocytes between the nodules are compressed and atrophic image .


TERMINOLOGY


Abbreviations




• Nodular regenerative hyperplasia (NRH)


Definitions




• Pattern of liver injury, associated with many underlying causes, that does not represent specific entity
image Formation of nodules with minimal or no fibrosis

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Apr 20, 2017 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Nodular Regenerative Hyperplasia
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