Abstract
Ten cases of multiple nodular hyperplasia of the liver, seven autopsy cases and three surgical cases, were studied clinicopathologically.
Clinical features were various, and portal hypertension was found in three surgical cases.
Macroscopically, in six autopsy cases the distribution of nodules was diffuse and in one it was scattered. In one case of the six cases with diffuse distribution the nodules were found with numerous metastatic adenocarcinoma of ovarial cancer.
Microscopically, nodules were composed of thickened hepatic cell cords consisting of hypertrophic cells. Expanded nodules compressed the surrounding liver parenchyma without fibrous capsules. Most of the nodules had a portal tract in the center, some had a few portal tracts or central vein. These individual microscopical features of the nodules coincide with those of nodular regenerative hyperplasia of the liver reported by Steiner.
Morphometrically, in the nodules, hepatic cells showed abundant cytoplasm, and nuclei were relatively monotonous. Sinusoidal spaces were narrowed. The nuclear DNA content of the nodular hepatic cells resembled that of the surrounding parenchyma.
In four autopsy cases and one surgical case portal fibrosis was seen. One of the autopsy cases had been treated with anti-convulsant drugs for a long term and there was portal fibrosis with partial fibrous bridgings.
In the case with scattered nodularity, severe sclerotic change of the arteries was seen in the portal areas, and complete obstruction in some portal areas.
The sclerotic change of the extrahepatic portal vein was more conspicious in the cases with portal fibrosis than in those without.
The nodules are considered to be caused by reactive hypertrophy of hepatic cells induced by disturbunce of intrahepatic microcirculation and hepatotrophic factors such as some hormones and drugs. And cases with scattered nodularity may exists as nodular regenerative hyperplasia different from that reported by Steiner.
