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Prevalence and clinical significance of nodular regenerative hyperplasia in liver biopsies
Author(s) -
Barge Sandrine,
Grando Véronique,
Nault JeanCharles,
Broudin Chloé,
Beaugrand Michel,
GanneCarrié Nathalie,
Roulot Dominique,
Ziol Marianne
Publication year - 2016
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12974
Subject(s) - nodular regenerative hyperplasia , pathology , medicine , clinical significance , hyperplasia , gastroenterology , portal hypertension , cirrhosis
Background Nodular regenerative hyperplasia ( NRH ) is a rare histological disorder associated with a wide variety of systemic diseases. Aims We aimed (i) to report the prevalence of NRH in a database of liver biopsies ( LB s) and the frequency of portal hypertension ( PHT ) at diagnosis, and (ii) to investigate whether associated diseases and/or specific histological lesions, including abnormalities of the microvasculature, were related to PHT . Methods Patients with a histological diagnosis of NRH , referred by seven clinical departments, were retrospectively selected. Clinical, biological, radiological, haemodynamic and endoscopic data at diagnosis were recorded. LB s were reassessed for microvascular abnormalities. Results NRH was diagnosed in 4.4% of LB s ( n = 159, male: 52%, mean age: 54). Among patients referred for unexplained liver enzyme abnormalities, 15% had NRH . PHT was present at diagnosis in 45 patients (38%), including 13 with portal thrombosis; 65% of patients had an associated disorder. Obliteration of portal vein branches, observed in the LB s of 17 patients (11%), was significantly associated with PHT ( P = 0.02). Periportal angiomatosis, observed in 101 patients (63%), was associated with the absence of PHT ( P < 10 −4 ). Conclusion We suggest that NRH is a frequent histological lesion in the setting of unexplained liver enzyme abnormalities. PHT is present at the time of diagnosis in 1/3 of patients regardless of the presence of associated disease. The frequency of periportal angiomatosis in NRH without obliteration of portal vein branches, and its association with the absence of PHT suggest that obstructive portal venopathy would not represent the most frequent mechanism involved in NRH .