Nodular regenerative hyperplasia of the liver in hepatocellular carcinoma. An autopsy study

To study the relationship between nodular regenerative hyperplasia of the liver (NRH) and hepatocellular carcinoma (HCC), we surveyed NRH in 11 autopsied noncirrhotic or nonfibrotic livers with HCC. NRH was found in one case, and focal nodular hyperplasia of hepatocytes (focal NRH-like changes) was noted in another four cases. Of particular interest was that these nodular hyperplastic areas did not show hepatocellular atypia such as liver cell dysplasia, nuclear atypia, pseudoglandular formation, and the loss or reduction of reticulin fibers. The one case of NRH and four cases of focal NRH-like changes had histories of transcatheter arterial embolization therapy or hepatic arterial infusion chemotherapy in which antineoplastic agents were directly infused into the feeding arteries of HCC. This treatment may produce intrahepatic microvascular damage, now accepted to be a potential cause of NRH. The results of this study suggested that in Japan NRH is a relatively rare underlying condition leading to HCC, and that the NRH or focal NRH-like changes in our cases might have developed secondarily to therapy for HCC administered via the hepatic vasculature.