Liver & intrahepatic bile ducts
Large regenerative nodule

Topic Completed: 1 February 2017

Minor changes: 1 August 2020

Revised: 25 January 2019, last major update February 2017

Copyright: (c) 2003-2018,, Inc.

PubMed Search: Large regenerative nodule

Naziheh Assarzadegan, M.D.
Raul S. Gonzalez, M.D.
Page views in 2019: 1,605
Page views in 2020 to date: 1,041
Cite this page: Assarzadegan N. Large regenerative nodule. website. Accessed August 14th, 2020.
Definition / general
  • Benign liver lesion frequently seen in Budd-Chiari syndrome and less commonly in other vascular disorders of the liver or systemic conditions such as autoimmune disease, myeloproliferative disorders and lymphoproliferative disorders (Radiographics 2002;22:847)
Essential features
  • Low grade regenerative hepatocellular nodule that often arises in the setting of flow abnormalities
  • Low malignant potential
  • Also known as benign regenerative nodule
Clinical features
Radiology description
  • Predominantly isointense or hypointense relative to background liver on T2 weighted images
Gross description
  • Multiple, well circumscribed, round lesions
  • Typically 0.5 - 4.0 cm
Gross images

Images hosted on other servers:

Large regenerative nodules,
along with other nodule
types and carcinoma

Microscopic (histologic) description
  • Nodules of hyperplastic hepatocytes arranged in thickened hepatic plates
  • No distinctive cytoarchitectural features (J Hepatol 2003;39:208)
  • Entrapped portal tracts often present
  • Surrounding parenchyma shows atrophy and congestion and may undergo fibrosis
Microscopic (histologic) images

Images hosted on PathOut server:

Images contributed by Naziheh Assarzadegan, M.D.:

Small cell change (10x)

Small cell change (40x)

Large cell change (20x)

Large cell change (40x)

Large cell change
(lower right) with
adjacent cirrhotic
nodule (upper left)

Images hosted on other servers:

Large cell change and small cell change

Large regenerative
nodule in a patient with
Budd-Chiari syndrome

Differential diagnosis
  • Low grade dysplastic nodule: similar to slightly higher malignant potential
    • Mild increase in cellularity, with occasional large cell change
  • Macroregenerative nodule: similar malignant potential
    • Generally occurs in cirrhosis
    • Similar if not identical by morphology
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