A case of nodular regenerative hyperplasia (NRH) diagnosed by laparoscopy

Abstract

A 50-year-old-woman complaining with general edema was referred to our hospital. Blood examination revealed slightly elevation of transaminases. However both HCV antibody and HBs antigen were not detected. Gastrointestinal endoscopy showed esophageal varices. Abdominal ultrasonography, abdominal CT and MRCP did not detected abnormal findings in the liver and splenomegaly. Laparoscopic examination was performed to take a liver biopsy. The gross laparoscopic findings have a mild thickened liver edge, diffuse yellowish-white nodules on the both liver lobes, mild hepatomegaly on the left lobe, but not swelling and atrophy on the right lobe. Histopathological findings of the liver tissue revealed partial hyperplasia and partial atrophy in the liver without fibrosis. We diagnosed nodular regenerative hyperplasia (NRH) of the liver.
Hepatic NRH is histologically characterized by nodular regeneration of hepatocyte without liver fibrosis and clinically complicated with portal hypertension and elevation of transaminases. Portal hypertension was detected in about 60% of patient with NRH. There is no effective treatment of NRH. Variceal hemorrhage is a sereous threat to life, thus esophageal varices which is recognized as high risk for bleeding should be treated.
Most cases of NRH of the liver were diagnosed by autopsy, so this is a valuable case. Here, we report a case of patient with hepatic NRH diagnosed by laparoscopic examination.