Nodular regenerative hyperplasia of the liver and antiphospholipid antibodies: report of two cases and review of the literature

Abstract

Nodular regenerative hyperplasia of the liver (NRHL) is a rare disorder characterized by diffuse micronodular transformation of the hepatic parenchyma without fibrous septa between the nodules. This condition appears to be associated in many ocasions with systemic autoimmune diseases. We describe two new patients with NRHL in whom antiphospholipid antibodies (aPL) were detected in their sera and review the few similar cases reported previously. We also discuss the possible relationship between aPL and NRHL and suggest that these antibodies may play a role in the pathogenesis of some cases of NRHL, specially those with an associated antiphospholipid syndrome.

Keywords

nodular regenerative hyperplasia of the liver antiphospholipid antibodies antiphospholipid syndrome

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References

Ranström S . Miliary hepatocellular adenomatosis . Acta Pathol Microbiol Scand 1953; 33: 225–229 .

Steiner PE . Nodular regenerative hyperplasia of the liver in Felty's syndrome . Q J Med 1959; 35: 943–953 .

Cervera R , Abós J , Bruguera M , Grau JM . Hiperplasia nodular regenerativa hepática y carcinoma gástrico . Rev Clin Esp 1987; 181: 341–342 .

Stromeyer FW , Ishak KG . Nodular transformation (nodular ‘regenerative’ hyperplasia of the liver). A clinicopathologic study of 30 cases . Human Pathol 1981; 12: 60–71 .

Wanless IR et al. Nodular regenerative hyperplasia of the liver associated with macroglobulinemia. A clue of pathogenesis . Am J Med 1981; 70: 1203–1209 .

Wanless IR . Micronodular transformation (nodular regenerative hyperplasia) of the liver: A report of 64 cases among 2500 autopsies and a new classification of benign hepatocellular nodules . Hepatology 1990; 11: 787–797 .

Asherson RA , Khamasta MA , Hughes GRV . The hepatic complications of the antiphospholipid antibodies . Clin Exp Rheumatol 1991; 9: 341–344 .

Cervera R , Asherson RA , Lie TJ . Clinicopathologic correlations of the antiphospholipid syndrome . Semin Arthitis Rheum 1995; 24: 262–272 .

Pérez-Ruiz F , Zea AC , Orte FJ . Antiphospholipid antibodies may play a role in the pathogenesis of nodular regenerative hyperplasia of the liver . Br J Rheumatol 1990; 29 (Suppl 2): 107-107 .

10.

Pérez-Ruiz F et al. Nodular regenerative hyperplasia of the liver in rheumatic diseases: report of seven cases and review of the literature . Semin Arthritis Rheum 1991; 21: 47–54 .

11.

Klemp P , Timme AH , Sayers GM . Systemic lupus erythematosus and nodular regenerative hyperplasia of the liver . Ann Rheum Dis 1986; 45: 167–170 .

12.

Harris M , Rash RM , Dymock IW . Nodular, non cirrhotic liver, associated with portal hypertension in a patient with rheumatoid arthritis . J Clin Pathol 1974; 27: 963–966 .

13.

Lie JT . Vasculopathy and the antiphospholipid syndrome: Thrombosis or vasculitis or both? J Rheumatol 1989; 16: 713–715 .(editorial).

14.

Elias M , Eldor A . Thromboembolism in patients with the ‘lupus-type’ circulating anticoagulant . Arch Intern Med 1984; 144: 510–515 .

15.

Minoshima S et al. A case of antiphospholipid syndrome associated with nodular regenerative hyperplasia and portal hypertension . J Jpa Soc Intern Med 1990; 79: 111–112 .

16.

Keegan AD , Brooks LT , Painter DM . Hepatic infarction and nodular regenerative hyperplasia of the liver with associated anticardiolipin antibodies in a young woman . J Clin Gastroenterol 1994; 18: 309–313 .

17.

Cadranel JF et al. Hyperplasie nodulaire régénérative associée aÁ un syndrome primaire des antiphospholipides . Gastroenterol Clin Biol 1996; 20: 901–904 .

18.

González-Alvaro Y , Carmona-Ortell L , Amigo-Etxenaguna , Castañeda S . Nodular regenerative hyperplasia of the liver and primary Sjögren's syndrome . J Rheumatol 1994; 21: 168–169 .

19.

Kaburaki J et al. Nodular regenerative hyperplasia of the liver in a patient with systemic sclerosis . Clin Rheumatol 1996; 15: 613–616 .

20.

Sekiya M et al. Nodular regenerative hyperplasia of the liver in systemic lupus erythematosus . Scand J Rheumatol 1997; 26: 215–217 .