Liver and intrahepatic bile ducts - tumor
High grade dysplastic nodule

Topic Completed: 1 December 2016

Revised: 25 January 2019, last major update December 2016

Copyright: (c) 2002-2018,, Inc.

PubMed search: High grade "dysplastic nodule" liver

Naziheh Assarzadegan, M.D.
Raul S. Gonzalez, M.D.
Page views in 2018: 2,247
Page views in 2019 to date: 1,897
Cite this page: Assarzadegan N. High grade dysplastic nodule. website. Accessed September 17th, 2019.
Definition / general
  • Discrete nodules in cirrhotic livers, containing high grade architectural and cytologic changes insufficient for a diagnosis of carcinoma (Hepatology 2009;49:658)
Essential features
  • Dysplastic nodules (both low grade and high grade) are associated with higher risk of development of hepatocellular carcinoma
  • High grade dysplastic nodules have a higher risk of transformation into hepatocellular carcinoma than low grade nodules (J Hepatol 2003;39:208) and themselves show molecular changes similar to carcinoma
  • Also called borderline nodule, macroregenerative nodule type II, atypical macroregenerative nodule, atypical adenomatous hyperplasia
Clinical features
  • Considered a precursor to hepatocellular carcinoma
  • Usually increase in size over time and do not regress
Radiology description
  • Reduced portal blood flow in the nodule on computed tomography is an important predictor for development of hepatocellular carcinoma (Cancer 2006;106:636)
  • Usually isovascular or hypovascular compared to surrounding parenchyma, whereas hepatocellular carcinoma appears hypervascular
  • Ablation or resection should be strongly considered
Gross description
  • Often vaguely nodular; can be a distinct nodule often in the background of cirrhosis
  • Lack a true capsule
  • Typically about 1 cm; can be single or multiple
Gross images

Images hosted on other servers:

High grade dysplastic
nodule, along with other
nodule types and carcinoma

Microscopic (histologic) description
  • Increased cellularity (more than 2 times higher than the adjacent nontumoral liver), often with an irregular trabecular pattern
  • Cytologic atypia is usually small cell change; large cell change may or may not be seen (Arch Pathol Lab Med 2011;135:704)
  • Portal tracts can be present within the nodules
  • Unpaired arteries can be present but not in great numbers (Dig Liver Dis 2011;43:S361)
  • "Nodule in nodule" appearance may be seen, where the larger nodule is a high grade dysplastic nodule and the inside subnodule is usually a well differentiated hepatocellular carcinoma
Microscopic (histologic) images

Images hosted on other servers:

Increased cellularity (C, D)

Trabecular pattern and small cell change (E)

Increased cellularity and unpaired arteries (B)

Molecular / cytogenetics description
  • Telomere shortening, increased telomerase activity and strong expression of hTERT mRNA at levels similar to hepatocellular carcinoma (Hepatology 2014;60:1983)
  • Inactivation of p21, in contrast to cirrhotic nodules, which show activation (Mod Pathol 2009;22:1121)
Differential diagnosis
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