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

Nakashima, Osamu; Kurogi, Mina; Yamaguchi, Rin; Miyaaki, Hisamitsu; Fujimoto, Masaru; Yano, Hirohisa; Kumabe, Tsutomu; Hayabuchi, Naohumi; Hisatomi, Junjiro; Sata, Michio; Kojiro, Masamichi

doi:10.1016/j.jhep.2004.08.014

Cited by 74 publications

(65 citation statements)

References 38 publications

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“…These radiologic findings were highly suggestive of HCC (23,24); however, the liver biopsy revealed a hepatocellular nodule with moderately increased cell density, miniaturization of nuclei, increased chromatin content, partial sinusoidal dilatation and congestion. These features were very similar to those of previous cases of hypervascular hyperplastic nodules (14,20,21,25), although scar-like fibrosis was not evident in our patient.…”

Section: Discussionsupporting

confidence: 91%

“…In 2004, three cases of regenerative hypervascular liver nodules classified according to the International Working Party were reported in patients without hepatitis B or C virus infection with a history of alcohol abuse (21). In the same year, reports of six cases of partial hepatectomy and six biopsies of C B A D small hypervascular nodules found in patients with alcoholic cirrhosis that were considered to be FNH-like nodules were published (14). Those nodules exhibited hypervascularity on angiography and histologically demonstrated unpaired arteries, an irregular trabecular pattern, scar-like fibrosis with anomalous blood vessels and a moderately increased cell density.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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A 64-year-old Japanese woman with a history of bronchiectasis presented with multiple hypervascular nodules in both lobes of the liver without hepatitis B or C virus infection. Imaging studies, including ultrasound, contrast-enhanced computed tomography and magnetic resonance imaging, showed hypervascularity in the early phase. Histologically, no lipid degeneration was observed; however, there was a mild increase in cell density, miniaturization of nuclei, increased chromatin content, partial sinusoidal dilatation and congestion. No unpaired arteries were evident. The diagnosis based on the pathology and diagnostic radiology findings was multiple hypervascular focal nodular hyperplasia (FNH)-like lesions with no history of alcohol abuse or chronic liver disease.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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“…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.…”

Section: Discussionmentioning

confidence: 82%

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

et al. 2012

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Hepatocellular adenoma usually arises in the absence of significant fibrosis. Herein, we report seven patients with serum amyloid A-positive hepatocellular neoplasm, which shares features with inflammatory hepatocellular adenoma arising in alcoholic cirrhosis. Seven patients (two women and five men, age range 41-67 years) with hypervascular hepatocellular nodules associated with alcoholic cirrhosis were retrieved from our pathological files (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011). The hepatocellular nodules were multiple (43) in all patients and 17 nodules were histologically examined. We surveyed the immunoreactivity for serum amyloid A, glutamine synthetase, and glypican-3 in the hepatocellular nodules and control lesions, including 5 focal nodular hyperplasia, 18 dysplastic nodules, and 54 hepatocellular carcinomas in various background diseases. In all, 15 of 17 nodules showed strong and distinct immunoreactivity for serum amyloid A, sharing features with inflammatory hepatocellular adenoma. The serum amyloid A-positive hepatocellular neoplasms showed increased cellular density, inflammatory infiltrate, sinusoidal dilatation, and ductular reaction to various degrees. Although about a half of dysplastic nodules and hepatocellular carcinomas showed focal immunoreactivity for serum amyloid A, the extent of serum amyloid A expression was significantly higher in serum amyloid A-positive hepatocellular neoplasms, than in control nodules. The serum amyloid A-positive hepatocellular neoplasms did not show the overexpression of glutamine synthetase or immunoreactivity for glypican-3. In contrast, most hepatocellular carcinomas showed the overexpression of glutamine synthetase and immunoreactivity for glypican-3, irrespective of background diseases. In conclusion, this study highlights a characteristic group of hepatocellular neoplasms arising in alcoholic cirrhosis, which share features with inflammatory hepatocellular adenomas. These serum amyloid Apositive hepatocellular neoplasms may be a new type of inflammatory hepatocellular tumors in alcoholic patients.

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“…Due to improvements in imaging techniques and pathological evaluation, a new type of small focal lesion occurring in the cirrhotic liver has been described (1)(2)(3). Focal nodular hyperplasia (FNH)-like nodules (FNH-like nodules) are focal lesions occurring in liver cirrhosis and are morphologically very similar to classical FNH in the otherwise normal liver.…”

Section: Introductionmentioning

confidence: 99%

Focal Nodular Hyperplasia-Like Nodule with Reduced Expression of Organic Anion Transporter 1B3 in Alcoholic Liver Cirrhosis

et al. 2011

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We report a patient with alcoholic liver cirrhosis who had a 15 mm focal nodular hyperplasia (FNH)-like nodule in the liver. This FNH-like nodule was diagnosed as hepatocellular carcinoma (HCC) mainly based on hypervascularity during the hepatic arterial phase, washout pattern during the equilibrium phase and low signal intensity during the hepatobiliary phase in gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI; it was surgically resected. Its histology exhibited hepatocyte hyperplasia, fibrous septa containing unpaired small arteries accompanied by reactive bile ductules, remarkable iron deposits and sinusoidal capillarization, and was compatible with the diagnosis of an FNH-like nodule. When we analyzed the images of the present nodule retrospectively, low signal intensity on in-phase and isosignal intensity on opposed-phase T1-weighted MRI may have reflected iron deposits in the FNH-like nodule. In addition, a low signal intensity on T2-weighted MRI and no detection in diffusion-weighted MRI may help in distinguishing FNH-like nodules from HCC, since these image findings are inconsistent with typical HCC. Immunohistochemical analysis revealed a markedly reduced expression of organic anion transporter (OATP) 1B3 in this nodule, which implied decreased Gd-EOB-DTPA uptake by hepatocytes and accounted for the low signal intensity during the hepatobiliary phase on Gd-EOB-DTPA-enhanced MRI. To the best of our knowledge this is the first report in which an FNH-like nodule was assessed for OATP1B3 expression.

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

Cited by 74 publications

References 38 publications

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

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

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

Focal Nodular Hyperplasia-Like Nodule with Reduced Expression of Organic Anion Transporter 1B3 in Alcoholic Liver Cirrhosis

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