Liver and intrahepatic bile ducts - Macroregenerative nodule

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Liver and intrahepatic bile ducts - Tumor

Dysplasia

Macroregenerative nodule

Reviewers: Deepali Jain, M.D. (see Reviewers page)
Revised: 9 January 2013, last major update February 2012
Copyright: (c) 2004-2013, PathologyOutlines.com, Inc.

General
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● Also called macrogenerative nodule type I, large regenerative nodule, adenomatous hyperplasia, hepatocellular pseudotumor, low grade dysplastic nodule
● May be clonal
● Usually ages 40+, 2/3 male
● May be due to disturbance in local blood flow
● Often static; 25% regress after radiographic follow up
● 15-20% risk of hepatocellular carcinoma in liver explants, 41% risk at autopsy

Treatment
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● Close follow-up (more frequent than in cirrhosis patients)

Gross description
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● Usually multiple, 0.5 to 1.5 cm, occasionally up to 5 cm
● Well-circumscribed by thin rim of fibrous tissue, but similar in color and texture to surrounding liver, may be pale or bile stained
● Found in 15-50% of cirrhotic livers, rarely in acute liver injury or precirrhotic livers

Micro description
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● Hepatocytes resemble those in remaining liver and may reflect disease process there (bile pigment, pseudoglands), liver cell plates 1-2 cells thick (with reticulin stain), reduced and scattered portal tracts with variable structural distortion (prominent bile ductules, absent interlobular bile ducts)
● May have architectural and cytologic atypia

Differential diagnosis
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● High grade dysplastic nodule: increased cellularity and unpaired arteries are useful to distinguish dysplastic nodules from large regenerative nodules of cirrhotic livers

End of Liver and intrahepatic bile ducts - Tumor > Dysplasia > Macroregenerative nodule

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