Adenomatous hyperplasia of the liver resembling focal nodular hyperplasia in patients with chronic liver disease

Abstract

Two nodules of hepatic adenomatous hyperplasia (AH) resembling focal nodular hyperplasia were found in two patients with cirrhosis or chronic active hepatitis. Imaging techniques suggested that the nodules were hepatocellular carcinoma. Pathological examination showed that the nodules (approximately 1.0 cm in diameter) were clearly demarcated from the surrounding liver tissue, and contained foci of scar-like fibrosis in the centre of the nodules. Microscopically, they contained portal tracts and fulfilled the criteria of AH. A large number of arteries were present in the central scar-like fibrosis as well as in the parenchyma of the nodules. There were foci of mildly atypical hepatocytes in one nodule but no cellular atypia in the other. Morphometric analysis showed that the cumulative luminal area of arteries per unit area was much greater in the nodules than in the extranodular liver tissues, while the cumulative luminal area of portal veins per unit area was much less in the nodules than in the extranodular liver tissues. Although the pathogenesis is unclear, these nodules might have developed through localized vascular changes associated with chronic liver disease, may have arisen from pre-existing arterial malformation, or may represent the early stages of angiogenesis in hepatocarcinogenesis.

A serum amyloid A-positive hepatocellular neoplasm arising in alcoholic cirrhosis: a previously unrecognized type of inflammatory hepatocellular tumor

“…11,15,16 This study disclosed that some such focal nodular hyperplasia-like nodules may be serum amyloid A-positive hepatocellular neoplasms/inflammatory hepatocellular adenomas. In fact, two of seven patients (patients 6 and 7) with serum amyloid A-positive hepatocellular neoplasms in this study had been diagnosed previously as hypervascular hyperplastic nodule/focal nodular hyperplasia-like nodules in our institute.…”

Unique hypervascular nodules in alcoholic liver cirrhosis: identical to focal nodular hyperplasia-like nodules?

“…Firstly, the matter of utmost concern is that the nodules are identical to FNH-like nodules previously reported in cirrhotic livers [15][16][17][18][19]. Quaglia et al [17] reported FNHlike nodules in explant cirrhotic livers.…”

“…At the same time, hyperplastic nodules and/or dysplastic nodules that are frequently hard to be differentiated from well-differentiated HCC became important subjects in clinical practice as well as in pathological interpretation [6][7][8][9][10][11][12][13][14]. Among them, unique hyperplastic nodules including focal nodular hyperplasia (FNH)-like nodules seen in cirrhotic livers became to attract the attention of both physicians and pathologists [15][16][17][18][19]. The nodules showed hypervascularity and/or a tumor stain on angiography resembling the imaging findings of HCC.…”

Multiple Hypervascular FNH-like Lesions in a Patient with No History of Alcohol Abuse or Chronic Liver Disease

“…Extranodular areas generally exhibit vascular changes, even if the changes are mild (27). Hence, although their exact cause could not be determined in our patient, the multiple hypervascular hyperplastic nodules may have resulted from abnormalities in hepatic hemodynamics, including microscopic arterial hyperplasia and a decreased number of portal veins (13).…”

“…Hence, benign hepatocellular nodules, such as FNH, NRH and partial nodular transformation, are considered to be caused by abnormal hepatic circulation, including either anomalous portal tract syndrome or anomalous vasculature syndrome (11). It has been reported that hypervascular hyperplastic nodules occur in association with severe alcoholic fibrosis or cirrhosis (12)(13)(14). Alcohol abuse is known to cause hyperplastic nodules in some cases that are usually associated with hypervascularity.…”