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Abstract
PURPOSE OF REVIEW Noncirrhotic portal hypertension represents a heterogeneous group of liver disorders that is characterized by portal hypertension in the absence of cirrhosis. The purpose of this review is to serve as a guide on how to approach a patient with noncirrhotic portal hypertension with a focus on recent developments. RECENT FINDINGS Recent studies pertaining to noncirrhotic portal hypertension have investigated aetiological causes, mechanisms of disease, noninvasive diagnostic modalities, clinical characteristics in the paediatric population and novel treatment targets. SUMMARY Noncirrhotic portal hypertension is an underappreciated clinical entity that can be difficult to diagnosis without a healthy suspicion. Diagnosis then relies on a comprehensive understanding of the causes and clinical manifestations of this disease, as well as a careful interpretation of the liver biopsy. Noninvasive approaches to diagnosis may play a significant role moving forward in this disease. Treatment in NCPH remains largely targeted at the individual sequalae of portal hypertension.
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Elsayes KM, Hooker JC, Agrons MM, Kielar AZ, Tang A, Fowler KJ, Chernyak V, Bashir MR, Kono Y, Do RK, Mitchell DG, Kamaya A, Hecht EM, Sirlin CB. 2017 Version of LI-RADS for CT and MR Imaging: An Update. Radiographics 2018; 37:1994-2017. [PMID: 29131761 DOI: 10.1148/rg.2017170098] [Citation(s) in RCA: 171] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Liver Imaging Reporting and Data System (LI-RADS) is a reporting system created for the standardized interpretation of liver imaging findings in patients who are at risk for hepatocellular carcinoma (HCC). This system was developed with the cooperative and ongoing efforts of an American College of Radiology-supported committee of diagnostic radiologists with expertise in liver imaging and valuable input from hepatobiliary surgeons, hepatologists, hepatopathologists, and interventional radiologists. In this article, the 2017 version of LI-RADS for computed tomography and magnetic resonance imaging is reviewed. Specific topics include the appropriate population for application of LI-RADS; technical recommendations for image optimization, including definitions of dynamic enhancement phases; diagnostic and treatment response categories; definitions of major and ancillary imaging features; criteria for distinguishing definite HCC from a malignancy that might be non-HCC; management options following LI-RADS categorization; and reporting. ©RSNA, 2017.
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Affiliation(s)
- Khaled M Elsayes
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Jonathan C Hooker
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Michelle M Agrons
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Ania Z Kielar
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - An Tang
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Kathryn J Fowler
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Victoria Chernyak
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Mustafa R Bashir
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Yuko Kono
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Richard K Do
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Donald G Mitchell
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Aya Kamaya
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Elizabeth M Hecht
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Claude B Sirlin
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
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Pathology of idiopathic non-cirrhotic portal hypertension. Virchows Arch 2018; 473:23-31. [DOI: 10.1007/s00428-018-2355-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/29/2018] [Accepted: 04/02/2018] [Indexed: 12/15/2022]
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Bi D, Malikowski TM, Sweetser S. Portal Hypertension and Unexplained Diarrhea in an 80-Year-Old Man. Gastroenterology 2018; 154:818-819. [PMID: 29122545 DOI: 10.1053/j.gastro.2017.10.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/19/2017] [Accepted: 10/25/2017] [Indexed: 12/02/2022]
Affiliation(s)
- Danse Bi
- Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Thomas M Malikowski
- Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Seth Sweetser
- Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota; Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
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Kleiner DE. Histopathological challenges in suspected drug-induced liver injury. Liver Int 2018; 38:198-209. [PMID: 28865179 DOI: 10.1111/liv.13584] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 08/25/2017] [Indexed: 12/13/2022]
Abstract
When a patient with suspected drug-induced liver injury (DILI) undergoes liver biopsy, the pathologist is confronted with two major challenges. The first and most important is to establish the pattern(s) of injury which are present. Patterns of injury represent stereotypical responses of an organ to injury and relate to specific aetiologies of liver damage. The pattern of injury and the histological details of that injury can then be analysed with respect to the patient's intercurrent diseases and medication history. The specific expertise of the pathologist can be used to weigh the prospect of DILI against the likelihood of other explanations of injury. The second challenge is to characterize specific types of injury and the severity of injury, both of which may have importance for clinical decision-making and prognosis. The pathologist's report should convey both an accurate description of the pathology as well its interpretation.
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Affiliation(s)
- David E Kleiner
- Post-Mortem Section, Laboratory of Pathology, National Cancer Institute, Bethesda, MD, USA
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Tang A, Hallouch O, Chernyak V, Kamaya A, Sirlin CB. Epidemiology of hepatocellular carcinoma: target population for surveillance and diagnosis. Abdom Radiol (NY) 2018. [PMID: 28647765 DOI: 10.1007/s00261-017-1209-1] [Citation(s) in RCA: 275] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hepatocellular carcinoma (HCC) is the sixth most common cancer and the second leading cause of cancer mortality worldwide. Incidence rates of liver cancer vary widely between geographic regions and are highest in Eastern Asia and sub-Saharan Africa. In the United States, the incidence of HCC has increased since the 1980s. HCC detection at an early stage through surveillance and curative therapy has considerably improved the 5-year survival. Therefore, medical societies advocate systematic screening and surveillance of target populations at particularly high risk for developing HCC to facilitate early-stage detection. Risk factors for HCC include cirrhosis, chronic infection with hepatitis B virus (HBV), hepatitis C virus (HCV), excess alcohol consumption, non-alcoholic fatty liver disease, family history of HCC, obesity, type 2 diabetes mellitus, and smoking. Medical societies utilize risk estimates to define target patient populations in which imaging surveillance is recommended (risk above threshold) or in which the benefits of surveillance are uncertain (risk unknown or below threshold). All medical societies currently recommend screening and surveillance in patients with cirrhosis and subsets of patients with chronic HBV; some societies also include patients with stage 3 fibrosis due to HCV as well as additional groups. Thus, target population definitions vary between regions, reflecting cultural, demographic, economic, healthcare priority, and biological differences. The Liver Imaging Reporting and Data System (LI-RADS) defines different patient populations for surveillance and for diagnosis and staging. We also discuss general trends pertaining to geographic region, age, gender, ethnicity, impact of surveillance on survival, mortality, and future trends.
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Affiliation(s)
- An Tang
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal and CRCHUM, 1058 rue Saint-Denis, Montréal, QC, H2X 3J4, Canada.
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.
| | - Oussama Hallouch
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal and CRCHUM, 1058 rue Saint-Denis, Montréal, QC, H2X 3J4, Canada
| | | | - Aya Kamaya
- Stanford University Medical Center, Stanford, CA, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego, La Jolla, CA, USA
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Koh C, Sakiani S, Surana P, Zhao X, Eccleston J, Kleiner DE, Herion D, Liang TJ, Hoofnagle JH, Chernick M, Heller T. Adult-onset cystic fibrosis liver disease: Diagnosis and characterization of an underappreciated entity. Hepatology 2017; 66:591-601. [PMID: 28422310 PMCID: PMC5519421 DOI: 10.1002/hep.29217] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/22/2017] [Accepted: 04/14/2017] [Indexed: 12/15/2022]
Abstract
UNLABELLED Cystic fibrosis (CF) liver disease (CFLD), a leading cause of death in CF, is mostly described in pediatric populations. Adult-onset CFLD lacks sufficient characterization and diagnostic tools. A cohort of CF patients without CFLD during childhood were followed for up to 38 years with serologic testing, imaging, and noninvasive fibrosis markers. Historical CFLD diagnostic criteria were compared with newly proposed CFLD criteria. Thirty-six CF patients were followed for a median of 24.5 years (interquartile range 15.6-32.9). By the last follow-up, 11 (31%) had died. With conventional criteria, 8 (22%) patients had CFLD; and by the new criteria, 17 (47%) had CFLD at a median age of 36.6 years (interquartile range 26.5-43.2). By the new criteria, those with CFLD had higher median alanine aminotransferase (42 versus 27, P = 0.005), aspartate aminotransferase (AST; 26 versus 21, P = 0.01), direct bilirubin (0.13 versus 0.1, P = 0.01), prothrombin time (14.4 versus 12.4, P = 0.002), and AST-to-platelet ratio index (0.31 versus 0.23, P = 0.003) over the last 2 years of follow-up. Subjects with a FibroScan >6.8 kPa had higher alanine aminotransferase (42 versus 28U/L, P = 0.02), AST (35 versus 25U/L, P = 0.02), AST-to-platelet ratio index (0.77 versus 0.25, P = 0.0004), and Fibrosis-4 index (2.14 versus 0.74, P = 0.0003) and lower platelet counts (205 versus 293, P = 0.02). One CFLD patient had nodular regenerative hyperplasia. Longitudinally, mean platelet counts significantly declined in the CFLD group (from 310 to 230 U/L, P = 0.0005). Deceased CFLD patients had lower platelet counts than those alive with CFLD (143 versus 258 U/L, P = 0.004) or those deceased with no CFLD (143 versus 327U/L, P = 0.006). CONCLUSION Adult-onset CFLD may be more prevalent than previously described, which suggests a later wave of CFLD that impacts morbidity; routine liver tests, radiologic imaging, noninvasive fibrosis markers, and FibroScan can be used algorithmically to identify adult CFLD; and further evaluation in other CF cohorts should be performed for validation. (Hepatology 2017;66:591-601).
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Affiliation(s)
- Christopher Koh
- Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Sasan Sakiani
- Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Pallavi Surana
- Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Xiongce Zhao
- Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Jason Eccleston
- Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - David E. Kleiner
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - David Herion
- Department of Clinical Research Informatics, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - T. Jake Liang
- Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Jay H. Hoofnagle
- Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Milica Chernick
- Office of the Director, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Theo Heller
- Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Koehne de Gonzalez AK, Lefkowitch JH. Heart Disease and the Liver: Pathologic Evaluation. Gastroenterol Clin North Am 2017; 46:421-435. [PMID: 28506373 DOI: 10.1016/j.gtc.2017.01.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Liver injury due to acute and chronic heart failure has long been recognized. This article discusses the concepts of acute cardiogenic liver injury (ACLI) and cardiac or congestive hepatopathy (CH) along with their clinical manifestations and sequelae. Histologically, ACLI manifests as centrilobular hepatocellular necrosis, whereas CH is associated with centrilobular hepatocyte atrophy, dilated sinusoids, and perisinusoidal fibrosis, progressing to bridging fibrosis and ultimately cirrhosis. ACLI is associated with marked increases in aminotransferase levels, whereas CH is associated with a cholestatic pattern of laboratory tests. Certain cardiac medications have also been implicated as a cause of liver fibrosis.
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Affiliation(s)
- Anne Knoll Koehne de Gonzalez
- Department of Pathology and Cell Biology, Columbia University, 630 West 168th Street, PH 15 West, Rm 1574, New York, NY 10032-3725, USA
| | - Jay H Lefkowitch
- Department of Pathology and Cell Biology, Columbia University, 630 West 168th Street, PH 15 West, Rm 1574, New York, NY 10032-3725, USA.
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60
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Tran-Minh ML, Sousa P, Maillet M, Allez M, Gornet JM. Hepatic complications induced by immunosuppressants and biologics in inflammatory bowel disease. World J Hepatol 2017; 9:613-626. [PMID: 28539989 PMCID: PMC5424291 DOI: 10.4254/wjh.v9.i13.613] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/01/2017] [Accepted: 04/24/2017] [Indexed: 02/06/2023] Open
Abstract
The incidence of inflammatory bowel diseases (IBD) is rising worldwide. The therapeutic options for IBD are expanding, and the number of drugs with new targets will rapidly increase in coming years. A rapid step-up approach with close monitoring of intestinal inflammation is extensively used. The fear of side effects represents one the most limiting factor of their use. Despite a widespread use for years, drug induced liver injury (DILI) management remains a challenging situation with Azathioprine and Methotrexate. DILI seems less frequent with anti-tumor necrosis factor agents and new biologic therapies. The aim of this review is to report incidence, physiopathology and practical guidelines in case of DILI occurrence with the armamentarium of old and new drugs in the field of IBD.
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61
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Hepatic Issues and Complications Associated With Inflammatory Bowel Disease: A Clinical Report From the NASPGHAN Inflammatory Bowel Disease and Hepatology Committees. J Pediatr Gastroenterol Nutr 2017; 64:639-652. [PMID: 27984347 DOI: 10.1097/mpg.0000000000001492] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatobiliary disorders are common in patients with inflammatory bowel disease (IBD), and persistent abnormal liver function tests are found in approximately 20% to 30% of individuals with IBD. In most cases, the cause of these elevations will fall into 1 of 3 main categories. They can be as a result of extraintestinal manifestations of the disease process, related to medication toxicity, or the result of an underlying primary hepatic disorder unrelated to IBD. This latter possibility is beyond the scope of this review article, but does need to be considered in anyone with elevated liver function tests. This review is provided as a clinical summary of some of the major hepatic issues that may occur in patients with IBD.
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62
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Philips C, Paramaguru R, Kumar L, Shenoy P, Augustine P. A Rare Cause of Portal Hypertension: Behcet's Disease and Nodular Regenerative Hyperplasia of the Liver. Cureus 2017; 9:e1125. [PMID: 28465872 PMCID: PMC5409820 DOI: 10.7759/cureus.1125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Nodular regenerative hyperplasia (NRH) is a rare liver condition in which widespread benign transformation of the hepatic parenchyma into small regenerative nodules occur, leading to development of non-cirrhotic portal hypertension. Conditions associated with NRH include rheumatologic, hematological, autoimmune, infectious, neoplastic, or drug-related etiology. Accurate diagnosis is made on liver biopsy, showing diffuse micronodular transformation in the absence of fibrosis. Here, we present the second case in world literature of a middle-aged man presenting with recent onset sleep reversal and memory loss with darkening of skin for four years associated with systemic manifestations, in whom porto-systemic shunt syndrome due to NRH secondary to Behcet’s disease was eventually diagnosed.
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Affiliation(s)
- Cyriac Philips
- Hepatology and Liver Transplant Medicine, PVS Memorial Hospital
| | | | | | | | - Philip Augustine
- Gastroenterology, PVS Institute of Digestive Diseases, PVS Memorial Hospital
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63
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Takyar V, Etzion O, Heller T, Kleiner DE, Rotman Y, Ghany MG, Fryzek N, Williams VH, Rivera E, Auh S, Liang TJ, Hoofnagle JH, Koh C. Complications of percutaneous liver biopsy with Klatskin needles: a 36-year single-centre experience. Aliment Pharmacol Ther 2017; 45:744-753. [PMID: 28074540 PMCID: PMC5290209 DOI: 10.1111/apt.13939] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 11/08/2016] [Accepted: 12/21/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Liver biopsy is the gold standard in evaluating liver diseases but is susceptible to complications. Safety data on aspiration needle biopsies remain limited. AIM To evaluate the safety of percutaneous liver biopsy performed with Klatskin needle. METHODS Clinical and biochemical data were retrospectively retrieved from sequential subjects who underwent liver biopsy with Klatskin needle from 1978 to 2015. Subjects with complications underwent thorough chart reviews for hospital course. RESULTS Of 3357 biopsies performed, complications occurred in 135 (4%) biopsies with 33 (1%) resulting in major complications. Severe pain occurred in 78 (2.3%) subjects and bleeding occurred in 21 (0.6%) subjects. Biliary injury occurred in 8 (0.2%) biopsies. Three subjects died as a result of massive intraperitoneal bleeding. Compared to viral hepatitis, biopsies performed with certain diagnosis had significantly higher odds of major complications: NRH (OR: 17), DILI (OR: 20), GVHD (OR: 32) and HCC (OR: 34). Subjects with major complications had higher pre-biopsy median AP (153 vs. 78 U/L, P < 0.001), ALT (105 vs. 64 U/L, P < 0.05), AST (62 vs. 47 U/L, P < 0.02), along with marginally lower total bilirubin (1.0 vs. 0.7 mg/dL, P < 0.01) and albumin (3.7 vs. 4.0 g/dL, P < 0.001). By multivariate backward logistic regression, platelets ≤100 K/μL and aPTT >35 were independent risk factors of post-biopsy bleeding. CONCLUSION Klatskin needle liver biopsies are safe with rare procedural morbidity. Our data suggests certain acutely ill subjects and those with systemic illnesses may be at higher risk of major complications. Clinicians should weigh the risks and benefits of liver biopsy in these patients with other alternative approaches.
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Affiliation(s)
- Varun Takyar
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Ohad Etzion
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Theo Heller
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - David E. Kleiner
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Yaron Rotman
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Marc G Ghany
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Nancy Fryzek
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Vanessa Haynes Williams
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Elenita Rivera
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Sungyoung Auh
- Office of the Director, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - T. Jake Liang
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Jay H. Hoofnagle
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher Koh
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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64
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Jin SM, Song SH, Cho YH, Shin DK, Shin SY, Kim GI, Park H, Rim KS. A case of nodular regenerative hyperplasia of the liver combined with toxic hepatitis. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 65:52-6. [PMID: 25603855 DOI: 10.4166/kjg.2015.65.1.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Nodular regenerative hyperplasia (NRH) is an uncommon liver condition characterized by diffuse transformation of the hepatic parenchyma into regenerative nodules without fibrosis. Portal vasculopathy caused by abnormal hepatic venous flow may induce hepatocyte hyperplasia, which forms regenerative nodules. Underlying diseases or certain drugs may also be the cause of NRH. This condition is often underdiagnosed as the patients remain asymptomatic until development of portal hypertension, and histopathologic confirmation by liver biopsy is the only way of making a definite diagnosis. The management mainly involves prevention and treatment of the complications of portal hypertension. The frequency of diagnosis of NRH has increased rapidly in recent years, however, only a few cases have been reported in Korea. Here, we report on a case of NRH of the liver combined with toxic hepatitis.
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Affiliation(s)
- Sun Mi Jin
- Departments of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sang Hee Song
- Departments of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Yang Hyun Cho
- Departments of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Dae Kyu Shin
- Departments of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sun Young Shin
- Departments of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Gwang Il Kim
- Departments of Pathology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Hana Park
- Departments of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Kyu Sung Rim
- Departments of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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65
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Meijer B, Simsek M, Blokzijl H, de Man RA, Coenraad MJ, Dijkstra G, van Nieuwkerk CM, Mulder CJ, de Boer NK. Nodular regenerative hyperplasia rarely leads to liver transplantation: A 20-year cohort study in all Dutch liver transplant units. United European Gastroenterol J 2016; 5:658-667. [PMID: 28815029 DOI: 10.1177/2050640616680550] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/18/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Nodular regenerative hyperplasia is an uncommon liver condition associated with several autoimmune disorders and drugs. The clinical symptoms of nodular regenerative hyperplasia vary from asymptomatic to severe complications of portal hypertension (nodular regenerative hyperplasia-syndrome). OBJECTIVE The purpose of this study was to identify the prognosis and optimal management, as well as the role of liver transplantation, in nodular regenerative hyperplasia. METHODS The pathology databases of all three Dutch liver transplant units were retrospectively scrutinised for explanted livers diagnosed with nodular regenerative hyperplasia or without clear diagnosis. Pre- and post-transplantation clinical, biochemical, radiological and histological information was obtained from electronic and paper records. RESULTS In total, 1886 patients received a liver transplant. In 255 patients, nodular regenerative hyperplasia could not be excluded. After detailed chart review, the native livers of 11 patients (0.6%) (82% male, median age: 44 years) displayed nodular regenerative hyperplasia. Seven patients (64%) had underlying disorders or drug exposure which possibly caused nodular regenerative hyperplasia. Laboratory and imaging abnormalities were present in all patients but did not contribute to the diagnosis of nodular regenerative hyperplasia. Five-year survival was 73% (median follow-up: four years, range: 2-248 months). CONCLUSION Nodular regenerative hyperplasia is a rare finding in patients, predominantly young males, transplanted for end-stage liver disease with unknown aetiology. Nonetheless, liver transplantation may have an important role in end-stage nodular regenerative hyperplasia-syndrome.
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Affiliation(s)
- Berrie Meijer
- Department of Gastroenterology and Hepatology, VU University Medical Center Amsterdam, The Netherlands
| | - Melek Simsek
- Department of Gastroenterology and Hepatology, VU University Medical Center Amsterdam, The Netherlands
| | - Hans Blokzijl
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert A de Man
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Minneke J Coenraad
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerard Dijkstra
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Carin Mj van Nieuwkerk
- Department of Gastroenterology and Hepatology, VU University Medical Center Amsterdam, The Netherlands
| | - Chris Jj Mulder
- Department of Gastroenterology and Hepatology, VU University Medical Center Amsterdam, The Netherlands
| | - Nanne Kh de Boer
- Department of Gastroenterology and Hepatology, VU University Medical Center Amsterdam, The Netherlands
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66
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Yoneda N, Matsui O, Kitao A, Kozaka K, Kobayashi S, Sasaki M, Yoshida K, Inoue D, Minami T, Gabata T. Benign Hepatocellular Nodules: Hepatobiliary Phase of Gadoxetic Acid-enhanced MR Imaging Based on Molecular Background. Radiographics 2016; 36:2010-2027. [PMID: 27740898 DOI: 10.1148/rg.2016160037] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Gadoxetic acid is a contrast agent for magnetic resonance (MR) imaging with hepatocyte-specific properties and is becoming increasingly important in detection and characterization of hepatocellular carcinoma and benign hepatocellular nodules, including focal nodular hyperplasia (FNH), nodular regenerative hyperplasia (NRH), hepatocellular adenoma (HCA), and dysplastic nodule. In these hepatocellular nodules, a positive correlation between the grade of membranous uptake transporter organic anion-transporting polypeptide (OATP) 1B3 expression and signal intensity in the hepatobiliary (HB) phase has been verified. In addition, it has been clarified that OATP1B3 expression is regulated by activation of β-catenin and/or hepatocyte nuclear factor 4α. On the other hand, recent studies have also revealed some of the background molecular mechanisms of benign hepatocellular nodules. FNH commonly shows iso- or hyperintensity in the HB phase with equal or stronger OATP1B3 expression, with map-like distribution of glutamine synthetase (a target of Wnt/β-catenin signaling) and OATP1B3 expression. NRH shows doughnut-like enhancement with hypointensity in the central portion in the HB phase with OATP1B3 expression. The majority of HCAs show hypointensity in the HB phase, but β-catenin-activated HCA exclusively demonstrates iso- or hyperintensity with increased expression of nuclear β-catenin, glutamine synthetase, and OATP1B3. Dysplastic nodule commonly shows iso- or hyperintensity in the HB phase with similar to increased OATP1B3 expression, but one-third of high-grade dysplastic nodules can be demonstrated as a hypointense nodule with decreased OATP1B3 expression. Knowledge of these background molecular mechanisms of gadoxetic acid-enhanced MR imaging is important not only for precise imaging diagnosis but also understanding of the pathogenesis of benign hepatocellular nodules. ©RSNA, 2016.
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Affiliation(s)
- Norihide Yoneda
- From the Departments of Radiology (N.Y., O.M., A.K., K.K., K.Y., D.I., T.M., T.G.), Quantum Medical Imaging (S.K.), and Human Pathology (M.S.), Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8640, Japan
| | - Osamu Matsui
- From the Departments of Radiology (N.Y., O.M., A.K., K.K., K.Y., D.I., T.M., T.G.), Quantum Medical Imaging (S.K.), and Human Pathology (M.S.), Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8640, Japan
| | - Azusa Kitao
- From the Departments of Radiology (N.Y., O.M., A.K., K.K., K.Y., D.I., T.M., T.G.), Quantum Medical Imaging (S.K.), and Human Pathology (M.S.), Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8640, Japan
| | - Kazuto Kozaka
- From the Departments of Radiology (N.Y., O.M., A.K., K.K., K.Y., D.I., T.M., T.G.), Quantum Medical Imaging (S.K.), and Human Pathology (M.S.), Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8640, Japan
| | - Satoshi Kobayashi
- From the Departments of Radiology (N.Y., O.M., A.K., K.K., K.Y., D.I., T.M., T.G.), Quantum Medical Imaging (S.K.), and Human Pathology (M.S.), Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8640, Japan
| | - Motoko Sasaki
- From the Departments of Radiology (N.Y., O.M., A.K., K.K., K.Y., D.I., T.M., T.G.), Quantum Medical Imaging (S.K.), and Human Pathology (M.S.), Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8640, Japan
| | - Kotaro Yoshida
- From the Departments of Radiology (N.Y., O.M., A.K., K.K., K.Y., D.I., T.M., T.G.), Quantum Medical Imaging (S.K.), and Human Pathology (M.S.), Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8640, Japan
| | - Dai Inoue
- From the Departments of Radiology (N.Y., O.M., A.K., K.K., K.Y., D.I., T.M., T.G.), Quantum Medical Imaging (S.K.), and Human Pathology (M.S.), Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8640, Japan
| | - Tetsuya Minami
- From the Departments of Radiology (N.Y., O.M., A.K., K.K., K.Y., D.I., T.M., T.G.), Quantum Medical Imaging (S.K.), and Human Pathology (M.S.), Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8640, Japan
| | - Toshifumi Gabata
- From the Departments of Radiology (N.Y., O.M., A.K., K.K., K.Y., D.I., T.M., T.G.), Quantum Medical Imaging (S.K.), and Human Pathology (M.S.), Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8640, Japan
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Milligan KL, Schirm K, Leonard S, Hussey AA, Agharahimi A, Kleiner DE, Fuss I, Lingala S, Heller T, Rosenzweig SD. Ataxia telangiectasia associated with nodular regenerative hyperplasia. J Clin Immunol 2016; 36:739-742. [PMID: 27671921 DOI: 10.1007/s10875-016-0334-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 09/05/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Ki L Milligan
- Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, MD, USA.,Primary Immunodeficiency Clinic, NIAID, NIH, Building 10, Room 2C410, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Karen Schirm
- Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, MD, USA
| | - Stephanie Leonard
- Division of Allergy and Immunology, University of California, San Diego, Rady Children's Hospital, San Diego, CA, USA
| | - Ashleigh A Hussey
- Primary Immunodeficiency Clinic, NIAID, NIH, Building 10, Room 2C410, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Anahita Agharahimi
- Primary Immunodeficiency Clinic, NIAID, NIH, Building 10, Room 2C410, 10 Center Drive, Bethesda, MD, 20892, USA
| | | | - Ivan Fuss
- Mucosal Immunity Section, NIAID NIH, Bethesda, MD, USA
| | | | - Theo Heller
- Liver Diseases Branch, NIDDK, NIH, Bethesda, MD, USA
| | - Sergio D Rosenzweig
- Primary Immunodeficiency Clinic, NIAID, NIH, Building 10, Room 2C410, 10 Center Drive, Bethesda, MD, 20892, USA. .,Immunology Service, Department of Laboratory Medicine, Clinical Center, NIH, Building 10, Room 2C410, 10 Center Drive, Bethesda, MD, 20892, USA.
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68
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Barge S, Grando V, Nault JC, Broudin C, Beaugrand M, Ganne-Carrié N, Roulot D, Ziol M. Prevalence and clinical significance of nodular regenerative hyperplasia in liver biopsies. Liver Int 2016; 36:1059-66. [PMID: 26415006 DOI: 10.1111/liv.12974] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/17/2015] [Indexed: 02/13/2023]
Abstract
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 (LBs) 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. LBs were reassessed for microvascular abnormalities. RESULTS NRH was diagnosed in 4.4% of LBs (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 LBs 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.
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Affiliation(s)
- Sandrine Barge
- Service d'Hépato-Gastro-entérologie, Groupe hospitalier Paris-Seine-Saint Denis, Hôpital Jean Verdier, France et Université Paris 13, Bobigny, France
| | - Véronique Grando
- Service d'Hépato-Gastro-entérologie, Groupe hospitalier Paris-Seine-Saint Denis, Hôpital Jean Verdier, France et Université Paris 13, Bobigny, France
| | - Jean-Charles Nault
- Service d'Hépato-Gastro-entérologie, Groupe hospitalier Paris-Seine-Saint Denis, Hôpital Jean Verdier, France et Université Paris 13, Bobigny, France.,Faculté de Médecine, INSERM UMR-1162, Génomique fonctionnelle des Tumeurs solides, IUH, France Université Paris Descartes, Paris, France
| | - Chloé Broudin
- Service d'Anatomie pathologique et Centre de Ressources biologiques, Groupe hospitalier Paris-Seine-Saint Denis, Hôpital Jean Verdier, France et Université Paris 13, Bobigny, France
| | - Michel Beaugrand
- Service d'Hépato-Gastro-entérologie, Groupe hospitalier Paris-Seine-Saint Denis, Hôpital Jean Verdier, France et Université Paris 13, Bobigny, France
| | - Nathalie Ganne-Carrié
- Service d'Hépato-Gastro-entérologie, Groupe hospitalier Paris-Seine-Saint Denis, Hôpital Jean Verdier, France et Université Paris 13, Bobigny, France.,Faculté de Médecine, INSERM UMR-1162, Génomique fonctionnelle des Tumeurs solides, IUH, France Université Paris Descartes, Paris, France
| | - Dominique Roulot
- UF Hépatologie, Groupe hospitalier Paris-Seine-Saint Denis, Hôpital Avicenne, AP-HP, France et Université Paris 13, Bobigny, France
| | - Marianne Ziol
- Faculté de Médecine, INSERM UMR-1162, Génomique fonctionnelle des Tumeurs solides, IUH, France Université Paris Descartes, Paris, France.,Service d'Anatomie pathologique et Centre de Ressources biologiques, Groupe hospitalier Paris-Seine-Saint Denis, Hôpital Jean Verdier, France et Université Paris 13, Bobigny, France
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69
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Guido M, Sarcognato S, Sonzogni A, Lucà MG, Senzolo M, Fagiuoli S, Ferrarese A, Pizzi M, Giacomelli L, Colloredo G. Obliterative portal venopathy without portal hypertension: an underestimated condition. Liver Int 2016; 36:454-60. [PMID: 26264219 DOI: 10.1111/liv.12936] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 07/30/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Obliterative portal venopathy without portal hypertension has been described by a single study in a limited number of patients, thus very little is known about this clinical condition. This study aimed to investigate the prevalence of obliterative portal venopathy and its clinical-pathological correlations in patients with cryptogenic chronic liver test abnormalities without clinical signs of portal hypertension. METHODS We analysed 482 liver biopsies from adults with non-cirrhotic cryptogenic chronic liver disorders and without any clinical signs of portal hypertension, consecutively enrolled in a 5-year period. Twenty cases of idiopathic non-cirrhotic portal hypertension diagnosed in the same period, were included for comparison. Histological findings were matched with clinical and laboratory features. RESULTS Obliterative portal venopathy was identified in 94 (19.5%) of 482 subjects and in all 20 cases of idiopathic non-cirrhotic portal hypertension: both groups shared the entire spectrum of histological changes described in the latter condition. The prevalence of incomplete fibrous septa and nodular regenerative hyperplasia was higher in the biopsies of idiopathic non-cirrhotic portal hypertension (P = 0.006 and P = 0.002), a possible hint of a more advanced stage of the disease. The two groups also shared several clinical laboratory features, including a similar liver function test profile, concomitant prothrombotic conditions and extrahepatic autoimmune disorders. CONCLUSION Obliterative portal venopathy occurs in a substantial proportion of patients with unexplained chronic abnormal liver function tests without portal hypertension. The clinical-pathological profile of these subjects suggests that they may be in an early (non-symptomatic) stage of idiopathic non-cirrhotic portal hypertension.
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Affiliation(s)
- Maria Guido
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Samantha Sarcognato
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Aurelio Sonzogni
- Pathology Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Maria Grazia Lucà
- Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Marco Senzolo
- Multivisceral Transplant Unit, Department of Surgical and Gastroenterological Sciences, University Hospital of Padova, Padova, Italy
| | - Stefano Fagiuoli
- Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Alberto Ferrarese
- Multivisceral Transplant Unit, Department of Surgical and Gastroenterological Sciences, University Hospital of Padova, Padova, Italy
| | - Marco Pizzi
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Luciano Giacomelli
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Guido Colloredo
- Department of Internal Medicine, San Pietro Hospital, Ponte San Pietro, Italy
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Hematopoietic Stem Cell Transplantation. PATHOLOGY OF TRANSPLANTATION 2016. [PMCID: PMC7124099 DOI: 10.1007/978-3-319-29683-8_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Semela D. Systemic disease associated with noncirrhotic portal hypertension. Clin Liver Dis (Hoboken) 2015; 6:103-106. [PMID: 31041001 PMCID: PMC6490659 DOI: 10.1002/cld.505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 07/20/2015] [Accepted: 08/29/2015] [Indexed: 02/04/2023] Open
Affiliation(s)
- David Semela
- Department of Biomedicine, Liver Biology LabUniversity BaselBaselSwitzerland,Division of Gastroenterology and HepatologyKantonsspitalSt. GallenSwitzerland
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Chiorean L, Cui XW, Tannapfel A, Franke D, Stenzel M, Kosiak W, Schreiber-Dietrich D, Jüngert J, Chang JM, Dietrich CF. Benign liver tumors in pediatric patients - Review with emphasis on imaging features. World J Gastroenterol 2015; 21:8541-8561. [PMID: 26229397 PMCID: PMC4515836 DOI: 10.3748/wjg.v21.i28.8541] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/16/2015] [Accepted: 05/21/2015] [Indexed: 02/07/2023] Open
Abstract
Benign hepatic tumors are commonly observed in adults, but rarely reported in children. The reasons for this remain speculative and the exact data concerning the incidence of these lesions are lacking. Benign hepatic tumors represent a diverse group of epithelial and mesenchymal tumors. In pediatric patients, most benign focal liver lesions are inborn and may grow like the rest of the body. Knowledge of pediatric liver diseases and their imaging appearances is essential in order to make an appropriate differential diagnosis. Selection of the appropriate imaging test is challenging, since it depends on a number of age-related factors. This paper will discuss the most frequently encountered benign liver tumors in children (infantile hepatic hemangioendothelioma, mesenchymal hamartoma, focal nodular hyperplasia, nodular regenerative hyperplasia, and hepatocellular adenoma), as well as a comparison to the current knowledge regarding such tumors in adult patients. The current emphasis is on imaging features, which are helpful not only for the initial diagnosis, but also for pre- and post-treatment evaluation and follow-up. In addition, future perspectives of contrast-enhanced ultrasound (CEUS) in pediatric patients are highlighted, with descriptions of enhancement patterns for each lesion being discussed. The role of advanced imaging tests such as CEUS and magnetic resonance imaging, which allow for non-invasive assessment of liver tumors, is of utmost importance in pediatric patients, especially when repeated imaging tests are needed and radiation exposure should be avoided.
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Jharap B, van Asseldonk DP, de Boer NKH, Bedossa P, Diebold J, Jonker AM, Leteurtre E, Verheij J, Wendum D, Wrba F, Zondervan PE, Colombel JF, Reinisch W, Mulder CJJ, Bloemena E, van Bodegraven AA. Diagnosing Nodular Regenerative Hyperplasia of the Liver Is Thwarted by Low Interobserver Agreement. PLoS One 2015; 10:e0120299. [PMID: 26054009 PMCID: PMC4459699 DOI: 10.1371/journal.pone.0120299] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 01/28/2015] [Indexed: 12/17/2022] Open
Abstract
Background and Aims Nodular regenerative hyperplasia (NRH) of the liver is associated with several diseases and drugs. Clinical symptoms of NRH may vary from absence of symptoms to full-blown (non-cirrhotic) portal hypertension. However, diagnosing NRH is challenging. The objective of this study was to determine inter- and intraobserver agreement on the histopathologic diagnosis of NRH. Methods Liver specimens (n=48) previously diagnosed as NRH, were reviewed for the presence of NRH by seven pathologists without prior knowledge of the original diagnosis or clinical background. The majority of the liver specimens were from thiopurine using inflammatory bowel disease patients. Histopathologic features contributing to NRH were also assessed. Criteria for NRH were modified by consensus and subsequently validated. Interobserver agreement was evaluated by using the standard kappa index. Results After review, definite NRH, inconclusive NRH and no NRH were found in 35% (23-40%), 21% (13-27%) and 44% (38-56%), respectively (median, IQR). The median interobserver agreement for NRH was poor (κ = 0.20, IQR 0.14-0.28). The intraobserver variability on NRH ranged between 14% and 71%. After modification of the criteria and exclusion of biopsies with technical shortcomings, the interobserver agreement on the diagnosis NRH was fair (κ = 0.45). Conclusions The interobserver agreement on the histopathologic diagnosis of NRH was poor, even when assessed by well-experienced liver pathologists. Modification of the criteria of NRH based on consensus effort and exclusion of biopsies of poor quality led to a fairly increased interobserver agreement. The main conclusion of this study is that NRH is a clinicopathologic diagnosis that cannot reliably be based on histopathology alone.
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Affiliation(s)
- Bindia Jharap
- Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, the Netherlands
- * E-mail:
| | - Dirk P. van Asseldonk
- Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, the Netherlands
| | - Nanne K. H. de Boer
- Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, the Netherlands
| | - Pierre Bedossa
- Department of Pathology, Beaujon Hospital, Paris, France
| | - Joachim Diebold
- Department of Pathology, Cantonal Hospital, Lucerne, Switzerland
| | - A. Mieke Jonker
- Department of Pathology, Refaja Hospital, Stadskanaal, the Netherlands
| | | | - Joanne Verheij
- Department of Pathology, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Fritz Wrba
- Department of Pathology, University Medical Center Vienna, Vienna, Austria
| | | | - Jean-Frédéric Colombel
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Walter Reinisch
- Department of Gastroenterology and Hepatology, University Medical Center Vienna, Vienna, Austria
| | - Chris J. J. Mulder
- Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, the Netherlands
| | - Elisabeth Bloemena
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Adriaan A. van Bodegraven
- Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, the Netherlands
- Department of Internal Medicine, Gastroenterology and Geriatrics, ORBIS Medical Center, Sittard-Geleen, the Netherlands
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Kleiner DE. Noncirrhotic portal hypertension: Pathology and nomenclature. Clin Liver Dis (Hoboken) 2015; 5:123-126. [PMID: 31040966 PMCID: PMC6490510 DOI: 10.1002/cld.459] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 01/24/2015] [Indexed: 02/04/2023] Open
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Abstract
Background Benign liver tumors are common. They do not spread to other areas of the body, and they usually do not pose a serious health risk. In fact, in most cases, benign liver tumors are not diagnosed because patients are asymptomatic. When they are detected, it’s usually because the person has had medical imaging tests, such as an ultrasound (US), computed tomography (CT) scan, or magnetic resonance imaging (MRI), for another condition. Materials and methods A search of the literature was made using cancer literature and the PubMed, Scopus, and Web of Science (WOS) database for the following keywords: “hepatic benign tumors”, “hepatic cystic tumors”, “polycystic liver disease”, “liver macroregenerative nodules”, “hepatic mesenchymal hamartoma”, “hepatic angiomyolipoma”, “biliary cystadenoma”, and “nodular regenerative hyperplasia”. Discussion and conclusion Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in some areas of the world; there is an increasing incidence worldwide. Approximately 750,000 new cases are reported per year. More than 75 % of cases occur in the Asia-Pacific region, largely in association with chronic hepatitis B virus (HBV) infection. The incidence of HCC is increasing in the USA and Europe because of the increased incidence of hepatitis C virus (HCV) infection. Unlike the liver HCC, benign tumors are less frequent. However, they represent a chapter always more interesting of liver disease. In fact, a careful differential diagnosis with the forms of malignant tumor is often required in such a way so as to direct the patient to the correct therapy. In conclusion, many of these tumors present with typical features in various imaging studies. On occasions, biopsies are required, and/or surgical removal is needed. In the majority of cases of benign hepatic tumors, no treatment is indicated. The main indication for treatment is the presence of significant clinical symptoms or suspicion of malignancy or fear of malignant transformation.
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Abstract
Hepatic involvement is often encountered in gastrointestinal (GI) diseases, in part because of the close anatomic and physiologic relations between the liver and GI tract. Drainage of the mesenteric blood supply to the portal vein permits absorbed and/or translocated nutrients, toxins, bacterial elements, cytokines, and immunocytes to gain hepatic access. Liver problems in digestive disorders may range from nonspecific hepatocellular enzyme elevations to significant pathologic processes that may progress to end-stage liver disease. Hepatobiliary manifestations of primary GI diseases in childhood and adolescence are not uncommon and include several well-described associations, such as sclerosing cholangitis with inflammatory bowel disease. Liver damage may also result from the effects of drugs used to treat GI diseases, for example, the hepatotoxicity of immunomodulatory therapies. This review highlights the important features of the hepatic and biliary abnormalities associated with 3 common pediatric GI conditions: inflammatory bowel disease, celiac disease, and cystic fibrosis.
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Alhosh R, Genyk Y, Alexopoulos S, Thomas D, Zhou S, Yanni G, Kerkar N. Hepatopulmonary syndrome associated with nodular regenerative hyperplasia after liver transplantation in a child. Pediatr Transplant 2014; 18:E157-60. [PMID: 24820314 DOI: 10.1111/petr.12281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2014] [Indexed: 12/12/2022]
Abstract
HPS is a significant complication of portal hypertension in children with chronic liver disease and is an established indication for LT. It is characterized clinically by the triad of pulmonary vascular dilatation causing hypoxemia in the setting of advanced liver disease. NRH, a cause of non-cirrhotic portal hypertension, is characterized by diffuse benign transformation of the hepatic parenchyma into small regenerative nodules with minimal or no fibrosis. Development of NRH and HPS in pediatric LT recipients has not been reported, although occasional cases have been reported in adult LT recipients. In this report, we discuss a case of a three-yr-old male who developed HPS, two yr after LT. Pulmonary and cardiac causes for hypoxemia were ruled out by appropriate investigations including a chest X ray, echocardiogram, cardiac catheterization, and a CT angiographic study. The diagnosis of HPS was confirmed via bubble echocardiogram that demonstrated intrapulmonary shunting. Open liver biopsy revealed marked NRH. The patient underwent liver retransplantation that resulted in complete reversal of his pulmonary symptoms and normal oxygen saturations within three months after LT.
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Affiliation(s)
- Rabea Alhosh
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital Los Angeles/Keck School of Medicine of USC, Los Angeles, CA, USA
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Diéras V, Harbeck N, Budd GT, Greenson JK, Guardino AE, Samant M, Chernyukhin N, Smitt MC, Krop IE. Trastuzumab emtansine in human epidermal growth factor receptor 2-positive metastatic breast cancer: an integrated safety analysis. J Clin Oncol 2014; 32:2750-7. [PMID: 25024070 DOI: 10.1200/jco.2013.54.4999] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The antibody-drug conjugate trastuzumab emtansine (T-DM1) combines the cytotoxic activity of DM1 with the human epidermal growth factor receptor 2 (HER2) -targeted, antitumor properties of trastuzumab. T-DM1 has shown activity in phase I and II single-arm studies in patients with pretreated HER2-positive metastatic breast cancer (MBC) and has demonstrated superior efficacy and improved tolerability versus standard MBC treatments in randomized phase II and III studies. This analysis, combining available data from all single-agent T-DM1 studies to date, was conducted to better define the T-DM1 safety profile. PATIENTS AND METHODS Six studies in patients with HER2-positive MBC who received T-DM1 3.6 mg/kg every 3 weeks and follow-up data from patients in an extension study were analyzed. Analyses included adverse events (AEs) by grade; AEs leading to death, drug discontinuation, or dose reduction; and select AEs. RESULTS Among 884 T-DM1-exposed patients, the most commonly reported all-grade AEs were fatigue (46.4%), nausea (43.0%), thrombocytopenia (32.2%), headache (29.4%), and constipation (26.5%). The most common grade 3 to 4 AEs were the laboratory abnormalities of thrombocytopenia (11.9%) and increased AST serum concentration (4.3%). These were manageable and not generally associated with clinical symptoms. There were 12 AE-related deaths. AEs resulted in dose reductions in 17.2% of patients and drug discontinuations in 7.0%. CONCLUSION In this analysis of 884 T-DM1-exposed patients, grade 3 or greater AEs were infrequent and typically asymptomatic and manageable. This favorable safety profile makes T-DM1 treatment suitable for exploration in other breast cancer settings.
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Affiliation(s)
- Véronique Diéras
- Véronique Diéras, Institut Curie, Paris, France; Nadia Harbeck, University of Munich, Munich, Germany; G. Thomas Budd, Cleveland Clinic, Lerner College of Medicine, Cleveland, OH; Joel K. Greenson, University of Michigan, Ann Arbor, MI; Ellie A. Guardino, Meghna Samant, Nataliya Chernyukhin, and Melanie C. Smitt, Genentech, South San Francisco, CA; and Ian E. Krop, Dana-Farber Cancer Institute, Boston, MA.
| | - Nadia Harbeck
- Véronique Diéras, Institut Curie, Paris, France; Nadia Harbeck, University of Munich, Munich, Germany; G. Thomas Budd, Cleveland Clinic, Lerner College of Medicine, Cleveland, OH; Joel K. Greenson, University of Michigan, Ann Arbor, MI; Ellie A. Guardino, Meghna Samant, Nataliya Chernyukhin, and Melanie C. Smitt, Genentech, South San Francisco, CA; and Ian E. Krop, Dana-Farber Cancer Institute, Boston, MA
| | - G Thomas Budd
- Véronique Diéras, Institut Curie, Paris, France; Nadia Harbeck, University of Munich, Munich, Germany; G. Thomas Budd, Cleveland Clinic, Lerner College of Medicine, Cleveland, OH; Joel K. Greenson, University of Michigan, Ann Arbor, MI; Ellie A. Guardino, Meghna Samant, Nataliya Chernyukhin, and Melanie C. Smitt, Genentech, South San Francisco, CA; and Ian E. Krop, Dana-Farber Cancer Institute, Boston, MA
| | - Joel K Greenson
- Véronique Diéras, Institut Curie, Paris, France; Nadia Harbeck, University of Munich, Munich, Germany; G. Thomas Budd, Cleveland Clinic, Lerner College of Medicine, Cleveland, OH; Joel K. Greenson, University of Michigan, Ann Arbor, MI; Ellie A. Guardino, Meghna Samant, Nataliya Chernyukhin, and Melanie C. Smitt, Genentech, South San Francisco, CA; and Ian E. Krop, Dana-Farber Cancer Institute, Boston, MA
| | - Alice E Guardino
- Véronique Diéras, Institut Curie, Paris, France; Nadia Harbeck, University of Munich, Munich, Germany; G. Thomas Budd, Cleveland Clinic, Lerner College of Medicine, Cleveland, OH; Joel K. Greenson, University of Michigan, Ann Arbor, MI; Ellie A. Guardino, Meghna Samant, Nataliya Chernyukhin, and Melanie C. Smitt, Genentech, South San Francisco, CA; and Ian E. Krop, Dana-Farber Cancer Institute, Boston, MA
| | - Meghna Samant
- Véronique Diéras, Institut Curie, Paris, France; Nadia Harbeck, University of Munich, Munich, Germany; G. Thomas Budd, Cleveland Clinic, Lerner College of Medicine, Cleveland, OH; Joel K. Greenson, University of Michigan, Ann Arbor, MI; Ellie A. Guardino, Meghna Samant, Nataliya Chernyukhin, and Melanie C. Smitt, Genentech, South San Francisco, CA; and Ian E. Krop, Dana-Farber Cancer Institute, Boston, MA
| | - Nataliya Chernyukhin
- Véronique Diéras, Institut Curie, Paris, France; Nadia Harbeck, University of Munich, Munich, Germany; G. Thomas Budd, Cleveland Clinic, Lerner College of Medicine, Cleveland, OH; Joel K. Greenson, University of Michigan, Ann Arbor, MI; Ellie A. Guardino, Meghna Samant, Nataliya Chernyukhin, and Melanie C. Smitt, Genentech, South San Francisco, CA; and Ian E. Krop, Dana-Farber Cancer Institute, Boston, MA
| | - Melanie C Smitt
- Véronique Diéras, Institut Curie, Paris, France; Nadia Harbeck, University of Munich, Munich, Germany; G. Thomas Budd, Cleveland Clinic, Lerner College of Medicine, Cleveland, OH; Joel K. Greenson, University of Michigan, Ann Arbor, MI; Ellie A. Guardino, Meghna Samant, Nataliya Chernyukhin, and Melanie C. Smitt, Genentech, South San Francisco, CA; and Ian E. Krop, Dana-Farber Cancer Institute, Boston, MA
| | - Ian E Krop
- Véronique Diéras, Institut Curie, Paris, France; Nadia Harbeck, University of Munich, Munich, Germany; G. Thomas Budd, Cleveland Clinic, Lerner College of Medicine, Cleveland, OH; Joel K. Greenson, University of Michigan, Ann Arbor, MI; Ellie A. Guardino, Meghna Samant, Nataliya Chernyukhin, and Melanie C. Smitt, Genentech, South San Francisco, CA; and Ian E. Krop, Dana-Farber Cancer Institute, Boston, MA
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LI-RADS Categorization of Benign and Likely Benign Findings in Patients at Risk of Hepatocellular Carcinoma: A Pictorial Atlas. AJR Am J Roentgenol 2014; 203:W48-69. [DOI: 10.2214/ajr.13.12169] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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81
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Rothweiler S, Heim MH, Semela D. Nodular regenerative hyperplasia in a patient with generalized essential telangiectasia: endotheliopathy as a causal factor. Hepatology 2014; 59:2419-21. [PMID: 24273032 DOI: 10.1002/hep.26942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 11/18/2013] [Indexed: 12/07/2022]
Affiliation(s)
- Sonja Rothweiler
- Department of Biomedicine, University Hospital Basel, University Basel, Basel, Switzerland
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Rothweiler S, Terracciano L, Tornillo L, Dill MT, Heim MH, Semela D. Downregulation of the endothelial genes Notch1 and ephrinB2 in patients with nodular regenerative hyperplasia. Liver Int 2014; 34:594-603. [PMID: 23870033 DOI: 10.1111/liv.12261] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 06/12/2013] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Nodular regenerative hyperplasia (NRH) is a rare liver disease characterized by small regenerative nodules without fibrosis and can cause portal hypertension. Aetiology and pathogenesis of NRH remain unclear. We have recently shown that Notch1 knockout induces NRH with portal hypertension through vascular remodelling in mice. The aim of this study was to analyse histological and clinical data of NRH patients and to explore if the endothelial pathways identified in our NRH mouse model are also regulated in human NRH. METHODS Patients were identified retrospectively from the pathology database. Clinical and laboratory patient data were retrieved. mRNA expression was measured in liver biopsies from a subset of NRH patients. RESULTS Diagnosis of NRH was confirmed in needle biopsies of 51 patients, including 31 patients with grade 1, 12 patients with grade 2 and 8 patients with grade 3 NRH. Grade 3 nodularity significantly correlated with the presence of portal hypertension: 50% of the patients with grade 3 NRH vs. 6.5% with grade 1 (P = 0.0105). mRNA expression analysis in liver biopsies from 14 NRH patients and in primary human sinusoidal endothelial cells revealed downregulation of identical genes as in the murine NRH model, which are implicated in vascular differentiation: Notch1, delta-like 4 (Dll4) and ephrinB2. CONCLUSIONS In this large NRH needle biopsy cohort, we demonstrated that advanced nodularity correlates with presence of portal hypertension. Downregulation of the endothelial signalling pathways Dll4/Notch1 and ephrinB2/EphB4 supports the hypothesis that human NRH is caused by a sinusoidal injury providing first insights into the molecular pathogenesis of this liver condition.
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Affiliation(s)
- Sonja Rothweiler
- Department of Biomedicine, University Hospital Basel, University Basel, Basel, Switzerland
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83
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Brunt EM, Gouw ASH, Hubscher SG, Tiniakos DG, Bedossa P, Burt AD, Callea F, Clouston AD, Dienes HP, Goodman ZD, Roberts EA, Roskams T, Terracciano L, Torbenson MS, Wanless IR. Pathology of the liver sinusoids. Histopathology 2014; 64:907-20. [PMID: 24393125 DOI: 10.1111/his.12364] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The hepatic sinusoids comprise a complex of vascular conduits to transport blood from the porta hepatis to the inferior vena cava through the liver. Under normal conditions, portal venous and hepatic artery pressures are equalized within the sinusoids, oxygen and nutrients from the systemic circulation are delivered to the parenchymal cells and differentially distributed throughout the liver acini, and proteins of liver derivation are carried into the cardiac/systemic circulation. Liver sinusoid structures are lined by endothelial cells unique to their location, and Kupffer cells. Multifunctional hepatic stellate cells and various immune active cells are localized within the space of Disse between the sinusoid and the adjacent hepatocytes. Flow within the sinusoids can be compromised by physical or pressure blockage in their lumina as well as obstructive processes within the space of Disse. The intimate relationship of the liver sinusoids to neighbouring hepatocytes is a significant factor affecting the health of hepatocytes, or transmission of the effects of injury within the sinusoidal space. Pathologists should recognize several patterns of injury involving the sinusoids and surrounding hepatocytes. In this review, injury, alterations and accumulations within the liver sinusoids are illustrated and discussed.
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Affiliation(s)
- Elizabeth M Brunt
- Department of Pathology and Immunology, Washington University, School of Medicine, St Louis, MO, USA
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Concurrent liver hodgkin lymphoma and nodular regenerative hyperplasia on an explanted liver with clinical diagnosis of alcoholic cirrhosis at university hospital fundación santa fe de bogotá. Case Rep Pathol 2014; 2014:193802. [PMID: 24511402 PMCID: PMC3912894 DOI: 10.1155/2014/193802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 12/11/2013] [Indexed: 11/17/2022] Open
Abstract
Liver involvement by Hodgkin lymphoma (HL) is well documented. However, secondary liver failure to this neoplastic process is rare and usually presents late in the course of the disease. We present a case of a HL associated with nodular regenerative hyperplasia (NRH) diagnosed on an explanted liver from a 53-year-old patient with clinical diagnosis of alcoholic cirrhosis. Hematoxylin and eosin stain (H&E) showed abnormal liver architecture with hepatocytes nodules highlighted by reticulin stain with absent fibrosis on the trichrome stain. The portal spaces had diffuse infiltration by Reed-Sternberg cells positive for CD15, CD30, and latent membrane protein (LMP) on immunohistochemical studies. The patient also had a concurrent hilar lymph node biopsy that also showed HL involvement. Liver failure as the initial presentation of Hodgkin' lymphoma is rare. We believe that more research about the utility of performing liver biopsies in patients candidates for transplantation with noncirrhotic hepatic failure is needed in order to establish the etiology and the optimal treatment.
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85
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Sood A, Castrejón M, Saab S. Human immunodeficiency virus and nodular regenerative hyperplasia of liver: A systematic review. World J Hepatol 2014; 6:55-63. [PMID: 24653794 PMCID: PMC3953810 DOI: 10.4254/wjh.v6.i1.55] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 12/13/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the diagnosis, pathogenesis, natural history, and management of nodular regenerative hyperplasia (NRH) in patients with human immunodeficiency virus (HIV).
METHODS: We performed a systematic review of the medical literature regarding NRH in patients with HIV. Inclusion criteria include reports with biopsy proven NRH. We studied the clinical features of NRH, in particular, related to its presenting manifestation and laboratory values. Combinations of the following keywords were implemented: “nodular regenerative hyperplasia”, “human immunodeficiency virus”, “noncirrhotic portal hypertension”, “idiopathic portal hypertension”, “cryptogenic liver disease”, “highly active antiretroviral therapy” and “didanosine”. The bibliographies of these studies were subsequently searched for any additional relevant publications.
RESULTS: The clinical presentation of patients with NRH varies from patients being completely asymptomatic to the development of portal hypertension – namely esophageal variceal bleeding and ascites. Liver associated enzymes are generally normal and synthetic function well preserved. There is a strong association between the occurrence of NRH and the use of antiviral therapies such as didanosine. The management of NRH revolves around treating the manifestations of portal hypertension. The prognosis of NRH is generally good since liver function is preserved. A high index of suspicion is required to make a identify NRH.
CONCLUSION: The appropriate management of HIV-infected persons with suspected NRH is yet to be outlined. However, NRH is a clinically subtle condition that is difficult to diagnose, and it is important to be able to manage it according to the best available evidence.
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Choe H, Aldoss I, Chaudhary P, Donovan J, Petrovic L, Pullarkat V. Nodular regenerative hyperplasia causing portal hypertension in a patient with chronic graft versus host disease: response to sirolimus. Acta Haematol 2014; 132:49-52. [PMID: 24434665 DOI: 10.1159/000356736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 10/08/2013] [Indexed: 02/04/2023]
Affiliation(s)
- Hannah Choe
- Jane Ann Nohl Division of Hematology, University of Southern California, Los Angeles, Calif., USA
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Shetty S, Adams DH, Hubscher SG. Post-transplant liver biopsy and the immune response: lessons for the clinician. Expert Rev Clin Immunol 2014; 8:645-61. [DOI: 10.1586/eci.12.65] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Musumba CO. Review article: the association between nodular regenerative hyperplasia, inflammatory bowel disease and thiopurine therapy. Aliment Pharmacol Ther 2013; 38:1025-37. [PMID: 24099468 DOI: 10.1111/apt.12490] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 06/18/2013] [Accepted: 08/27/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Nodular regenerative hyperplasia (NRH) is increasingly being recognised in patients with inflammatory bowel disease (IBD). However, the pathogenesis and incidence of NRH in IBD, and the putative roles played by azathioprine (AZA), mercaptopurine (MP), or tioguanine (TG) remain unclear. AIMS To summarise the data on the association between NRH and thiopurine therapy in patients with IBD. METHODS A literature search was performed in PubMed and MEDLINE databases using the keywords 'nodular regenerative hyperplasia AND (inflammatory bowel disease OR Crohn's disease OR ulcerative colitis) AND (azathioprine OR mercaptopurine OR tioguanine OR thioguanine).' No time limit was placed on studies included. RESULTS Inflammatory bowel disease patients treated with AZA have a cumulative incidence of NRH of approximately 0.6% and 1.28% at 5 and 10 years, respectively, whereas those treated with high-dose TG (>40 mg/day) have a frequency of NRH of up to 62%, which is higher in patients with elevated liver enzymes and/or thrombocytopaenia than those without these abnormalities (frequency 76% vs. 33%). Conversely, low-dose TG therapy (<20 mg/day) is relatively safe, with no cases of NRH observed. NRH has also been found in 6% of operated thiopurine-naïve IBD patients. Male gender, older age, and stricturing disease/small bowel resection have been consistently identified as high-risk factors for NRH. CONCLUSIONS The pathogenesis of nodular regenerative hyperplasia in patients with IBD is complex and multifactorial involving disease-specific, genetic and iatrogenic risk factors. Clinicians should maintain a high index of suspicion for diagnosing nodular regenerative hyperplasia, especially in IBD patients with high-risk factors on thiopurine therapy, regardless of the presence of laboratory abnormalities.
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Affiliation(s)
- C O Musumba
- Department of Gastroenterology and Hepatology, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
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90
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Aggarwal S, Fiel MI, Schiano TD. Obliterative portal venopathy: a clinical and histopathological review. Dig Dis Sci 2013; 58:2767-76. [PMID: 23812828 DOI: 10.1007/s10620-013-2736-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 05/29/2013] [Indexed: 12/12/2022]
Abstract
Non-cirrhotic portal hypertension (NCPH) is characterized by the elevation of the portal pressure in the absence of cirrhosis. Obliterative portal venopathy (OPV) as a cause of NCPH is being increasingly diagnosed, especially after recent reports of its occurrence in patients with HIV using didanosine. Patients usually present with episodes of variceal hemorrhage and other features of portal hypertension including jaundice, ascites, encephalopathy and hepatopulmonary syndrome. Hepatic synthetic function is typically well preserved and the laboratory evaluation in OPV patients typically reveals only mild nonspecific hematological abnormalities chiefly related to hypersplenism. Its diagnosis remains a challenge and patients are often mistakenly diagnosed as having cirrhosis. Despite the increasing recognition of OPV, its etiology and pathogenesis are still unclear. A number of etiologies have been proposed including genetic predisposition, recurrent bacterial infections, HIV infection and highly active antiretroviral therapy, an altered immune response, hypercoagulability, and exposure to chemicals and certain medications. Histopathological evaluation remains critical in excluding cirrhosis and other causes of portal hypertension, and is the only way of definitively establishing the diagnosis of OPV. Clinicians should have a high index of suspicion for OPV in patients who present with variceal bleeding and splenomegaly and who do not have other features of cirrhosis. The purpose of this review is to summarize the known etiologies for OPV and its associated clinical aspects and correlations, and to also provide ample histophotomicrographs of OPV to aid in the diagnosis. It will also help raise awareness of this entity amongst pathologists and clinicians alike.
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Affiliation(s)
- Sourabh Aggarwal
- School of Medicine, Western Michigan University, Kalamazoo, MI, USA
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91
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Portal Hypertension, Nodular Regenerative Hyperplasia of the Liver, and Obstructive Portal Venopathy due to Metastatic Breast Cancer. Case Rep Pathol 2013; 2013:826284. [PMID: 23984149 PMCID: PMC3747434 DOI: 10.1155/2013/826284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 07/09/2013] [Indexed: 11/17/2022] Open
Abstract
Nodular regenerative hyperplasia (NRH) of the liver is associated with noncirrhotic portal hypertension, rheumatologic and hematologic disorders, administration of certain drugs, and other underlying conditions. This report describes a 64-year-old man with clinically presumed cirrhosis who presented to our institution with coffee-ground emesis, esophageal varices, ascites, and encephalopathy. Eleven years earlier he had been treated for breast cancer with mastectomy and chemo-radiotherapy. He died suddenly, and the autopsy showed no evidence of cirrhosis but instead demonstrated NRH with extensive emboli of recurrent breast carcinoma within the portal vein and its intrahepatic branches. Neoplastic occlusion of the portal vein as a cause of presinusoidal noncirrhotic portal hypertension has not previously been reported for metastatic breast carcinoma. This case highlights the importance of obstructive portal venopathy in the pathogenesis of NRH as well as the diagnostic difficulties that may be encountered in determining the cause of portal hypertension.
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92
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Harry BL, Smith ML, Burton JR, Dasari A, Eckhardt SG, Diamond JR. Medullary thyroid cancer and pseudocirrhosis: case report and literature review. ACTA ACUST UNITED AC 2013; 19:e36-41. [PMID: 22328846 DOI: 10.3747/co.19.840] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Pseudocirrhosis is a rare form of liver disease that can cause clinical symptoms and radiographic signs of cirrhosis; however, its histologic features suggest a distinct pathologic process. In the setting of cancer, hepatic metastases and systemic chemotherapy are suspected causes of pseudocirrhosis. Here, we present a patient with medullary thyroid carcinoma metastatic to the liver who developed pseudocirrhosis while on maintenance sunitinib after receiving 5-fluorouracil, leucovorin, and oxaliplatin (folfox) in combination with sunitinib. Cirrhotic change in liver morphology was accompanied by diffusely infiltrative carcinomatous disease resembling the primary tumor. We discuss the diagnosis of pseudocirrhosis in this case and review the literature regarding pseudocirrhosis in cancer.
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Affiliation(s)
- B L Harry
- Medical Scientist Training Program, University of Colorado at Denver, Anschutz Medical Campus, Aurora, CO, U.S.A
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93
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Fuss IJ, Friend J, Yang Z, He JP, Hooda L, Boyer J, Xi L, Raffeld M, Kleiner DE, Heller T, Strober W. Nodular regenerative hyperplasia in common variable immunodeficiency. J Clin Immunol 2013; 33:748-58. [PMID: 23420139 DOI: 10.1007/s10875-013-9873-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 01/23/2013] [Indexed: 01/21/2023]
Abstract
PURPOSE Patients with Common Variable Immunodeficiency (CVID) are subject to the development of a liver disease syndrome known as nodular regenerative hyperplasia (NRH). The purpose of this study was to define the characteristics and course of this complication of CVID. METHODS CVID patients were evaluated by retrospective and prospective clinical course review. Liver biopsy specimens were evaluated for evidence of NRH and studied via RT-PCR for cytokine analysis. RESULTS NRH in our CVID patient population occurred in approximately 5 % of the 261 patients in our total CVID study group, initially presenting in most cases with an elevated alkaline phosphatase level. While in some patients the disease remained static, in a larger proportion a more severe disease developed characterized by portal hypertension, the latter leading to hypersplenism with neutropenia and thrombocytopenia and, in some cases, to ascites. In addition, a substantial proportion of patients either developed or presented initially with an autoimmune hepatitis-like (AIH-like) liver disease that resulted in severe liver dysfunction and, in most cases to death due to infections. The liver histologic findings in these AIH-like patients were characterized by underlying NRH pattern with superimposed interface hepatitis, lymphocytic infiltration and fibrosis. Immunologic studies of biopsies of NRH patients demonstrated the presence of infiltrating T cells producing IFN-γ, suggesting that the NRH is due to an autoimmune process. CONCLUSION Overall, these studies provide evidence that NRH may not be benign but, can be a severe and potentially fatal disease complication of CVID that merits close monitoring and intervention.
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Affiliation(s)
- Ivan J Fuss
- Mucosal Immunity Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
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94
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Rodríguez de Lope C, Reig ME, Darnell A, Forner A. Approach of the patient with a liver mass. Frontline Gastroenterol 2012; 3:252-262. [PMID: 28839677 PMCID: PMC5369839 DOI: 10.1136/flgastro-2012-100146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 07/09/2012] [Accepted: 07/11/2012] [Indexed: 02/04/2023] Open
Abstract
The widespread use of imaging techniques has led to an increased diagnosis of incidental liver tumours. The differential diagnosis is extremely broad since it may range from benign asymptomatic lesions to malignant neoplasms. The correct characterisation of a liver mass has become a diagnostic challenge for most clinicians. They can be divided in two major categories; cystic lesions, usually benign with excellent long-term outcome, and solid lesions, in which malignancy should be excluded. A particular population is those patients with cirrhosis, who have high risk for hepatocellular carcinoma development. Dynamic imaging techniques have a pivotal role in the diagnostic work-up of liver tumours, allowing a confident diagnosis in most cases. If imaging is not conclusive, a biopsy should be requested to obtain a definitive diagnosis.
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Affiliation(s)
- Carlos Rodríguez de Lope
- Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - María E Reig
- Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Anna Darnell
- Barcelona Clinic Liver Cancer (BCLC) Group, Radiology Department, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alejandro Forner
- Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
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95
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Parente DB, Perez RM, Eiras-Araujo A, Oliveira Neto JA, Marchiori E, Constantino CP, Amorim VB, Rodrigues RS. MR imaging of hypervascular lesions in the cirrhotic liver: a diagnostic dilemma. Radiographics 2012; 32:767-87. [PMID: 22582358 DOI: 10.1148/rg.323115131] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cirrhosis is characterized by a spectrum of hepatocellular nodules that mark the progression from regenerative nodules to low- and high-grade dysplastic nodules, followed by small and large hepatocellular carcinomas (HCCs). Characterization of small nodules on the basis of imaging and histopathologic findings is complicated by an overlap in findings associated with each type of nodule, a reflection of their multistep transitions. Vascularity patterns change gradually as the nodules evolve, with an increasing shift from predominantly venous to predominantly arterial perfusion. Regenerative and low-grade dysplastic nodules demonstrate predominantly portal perfusion and contrast enhancement similar to that of surrounding parenchyma. Differentiation of high-grade dysplastic nodules and well-differentiated HCCs on the basis of dynamic imaging and histologic findings is challenging, with a high rate of false-negative results. Some small nodules that lack hypervascularity may be early HCCs. Progressed small and large HCCs usually present no diagnostic difficulty because of their characteristic findings. Although characterization of hypervascular lesions in the cirrhotic liver is difficult, it is a key step in disease management and is the radiologist's responsibility.
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Affiliation(s)
- Daniella B Parente
- Federal University of Rio de Janeiro, Av. Lineu de Paula Machado 896/601, Jardim Botânico, CEP 22470-040, Rio de Janeiro, Brazil.
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96
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Granulomatous Disease in CVID: Retrospective Analysis of Clinical Characteristics and Treatment Efficacy in a Cohort of 59 Patients. J Clin Immunol 2012; 33:84-95. [DOI: 10.1007/s10875-012-9778-9] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 08/21/2012] [Indexed: 10/27/2022]
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97
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Jackson BD, Doyle JS, Hoy JF, Roberts SK, Colman J, Hellard ME, Sasadeusz JJ, Iser DM. Non-cirrhotic portal hypertension in HIV mono-infected patients. J Gastroenterol Hepatol 2012; 27:1512-9. [PMID: 22497527 DOI: 10.1111/j.1440-1746.2012.07148.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM Unexplained liver injury including fibrosis and portal hypertension has rarely been reported among patients with HIV in the absence of co-infection with hepatitis B (HBV) or hepatitis C (HCV). We describe a series of HIV mono-infected patients with evidence of non-cirrhotic portal hypertension. METHODS HIV-infected patients with evidence of portal hypertension who were anti-HBV and anti-HCV negative and HBV and HCV RNA polymerase chain reaction (PCR) negative were identified from patients managed by the Victorian statewide HIV referral service located at The Alfred Hospital, Melbourne. Portal hypertension was defined as either radiological or endoscopic evidence of varices, portal vein flow obstruction, or elevated hepatic venous pressure gradient (HPVG). RESULTS Five patients were found to have portal hypertension. These patients were male, aged 41 to 65 years, with known duration of HIV infection between 11 to 25 years. All had been treated with antiretroviral therapy, including didanosine. Tests for metabolic, autoimmune, and hereditary causes of liver disease failed to establish an etiology for the liver injury. All had radiological or endoscopic findings of varices, and four patients had radiological features of portal vein obstruction or flow reversal. Only one patient underwent HPVG measurement, which was elevated. Non-invasive fibrosis assessment revealed increased liver stiffness in three (out of four) patients, and no cirrhotic features were found on those who underwent liver biopsy. CONCLUSIONS To our knowledge, this is the largest published series of non-cirrhotic portal hypertension in HIV mono-infected patients in Australia. Further research is needed to understand what relationship, if any, HIV or its treatments might have on liver injury over time.
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Affiliation(s)
- Belinda D Jackson
- Department of Gastroenterology, The Alfred Hospital Infectious Diseases Unit, The Alfred Hospital, Australia
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98
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Bissonnette J, Généreux A, Côté J, Nguyen B, Perreault P, Bouchard L, Pomier-Layrargues G. Hepatic hemodynamics in 24 patients with nodular regenerative hyperplasia and symptomatic portal hypertension. J Gastroenterol Hepatol 2012; 27:1336-40. [PMID: 22554152 DOI: 10.1111/j.1440-1746.2012.07168.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM To evaluate hepatic hemodynamics in patients with nodular regenerative hyperplasia of the liver (NRH) with portal hypertension (PHT). METHODS We retrospectively reviewed the charts of 24 patients referred for PHT related to biopsy-proven NRH. Hemodynamic measurements included wedged hepatic vein (WHVP) and inferior vena cava (IVCP), and, in 12 patients, portal vein pressure (PVP). Hepatic vein pressure gradient (HVPG: WHVP-IVCP) and portal vein pressure gradient (PVPG: PVP-IVCP) were calculated. RESULTS Nodular regenerative hyperplasia was associated in 24 patients with various diseases (oxaliplatin chemotherapy, treatment with purine antagonists, post liver transplantation, hematologic and rheumatologic conditions and HIV infection). Liver function parameters were either completely normal or slightly impaired. Patients were referred for gastroesophageal varices (n = 18), and/or ascites (n = 11), and/or splenomegaly (n = 20). In patients with varices or ascites, HVPG was lower than 10 mmHg (a cut-off point for the presence of varices and/or ascites) in 15/21, suggesting a pre-sinusoidal component to their PHT confirmed by a PVP higher than 12 mmHg in 12/12 patients. The mean difference between HVPG and PVPG was 8.7 mmHg in these patients. Ten patients were treated by transjugular intrahepatic portosystemic shunt. None of them re-bled, and one presented transient hepatic encephalopathy. CONCLUSIONS Presinusoidal PHT associated with NRH is probably related to compression of portal venules by the regenerative nodules. In patients with HTP and a HVPG < 10 mmHg, the diagnosis of NRH must be suspected and PVP measured, which is important in the management of these patients.
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99
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Chapel H, Lucas M, Patel S, Lee M, Cunningham-Rundles C, Resnick E, Gerard L, Oksenhendler E. Confirmation and improvement of criteria for clinical phenotyping in common variable immunodeficiency disorders in replicate cohorts. J Allergy Clin Immunol 2012; 130:1197-1198.e9. [PMID: 22819511 DOI: 10.1016/j.jaci.2012.05.046] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 05/18/2012] [Accepted: 05/21/2012] [Indexed: 10/28/2022]
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100
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Greene J, DiPasco P, Koshenkov V, Livingstone A. Portal hypertension from nodular regenerative hyperplasia of the liver treated with distal splenorenal shunt. J Surg Case Rep 2012; 2012:2. [PMID: 24960727 PMCID: PMC3649562 DOI: 10.1093/jscr/2012.7.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Portal hypertension (PH) is a devastating sequelae of several pathologic entities, with alcoholic cirrhosis being the most common cause in the western world and endemic schistosomiasis worldwide. A much less common aetiology of non-cirrhotic PH is nodular regenerative hyperplasia (NRH) of the liver. The hallmark of NRH is a benign remodeling of the hepatic parenchyma into regenerative nodules in the absence of fibrosis (1). A Warren-Zeppa Distal Splenorenal Shunt (DSRS) was performed in a young patient with NRH of the liver to alleviate PH. This procedure was chosen due to its low postoperative rates of hepatic insufficiency and high durability.
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