Liver & intrahepatic bile ducts


Large regenerative nodule

Last author update: 27 January 2021
Last staff update: 28 January 2021

Copyright: 2003-2024,, Inc.

PubMed Search: large regenerative nodule liver review[ptyp]

Naziheh Assarzadegan, M.D.
Raul S. Gonzalez, M.D.
Page views in 2023: 3,150
Page views in 2024 to date: 1,075
Cite this page: Assarzadegan N, Gonzalez RS. Large regenerative nodule. website. Accessed April 14th, 2024.
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
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

Contributed by Naziheh Assarzadegan, M.D.

Small cell change

Large cell change

Large cell change with adjacent cirrhotic nodule

Images hosted on other servers:

Large regenerative
nodule in a patient with
Budd-Chiari syndrome

Sample pathology report
  • Liver, native, orthotopic transplantation:
    • Liver parenchyma with bridging fibrosis, prominent sinusoidal dilation and focal large regenerative nodules (see comment)
    • Negative for malignancy.
    • Margins of resection unremarkable.
    • Comment: The findings are consistent with the patient’s reported history of congestive heart failure. The simultaneously explanted heart will be reported separately. A trichrome stain shows bridging fibrosis, focally approaching early cirrhosis. An iron stain is unremarkable.
Differential diagnosis
  • Low grade dysplastic nodule:
    • Mild increase in cellularity, with occasional large cell change
    • Similar to slightly higher malignant potential
  • Macroregenerative nodule:
    • Similar malignant potential
    • Generally occurs in cirrhosis
    • Similar if not identical by morphology
Board review style question #1
Large regenerative nodules of the liver often arise in the setting of

  1. Biliary injury
  2. Chronic viral hepatitis
  3. Cirrhosis
  4. Vascular flow abnormalities
Board review style answer #1
D. Vascular flow abnormalities

Comment Here

Reference: Large regenerative nodule
Back to top
Image 01 Image 02