Liver nodules

Introduction Liver nodules are formed by various factors that cause liver fibrosis and cause disorder of hepatic trabecular alignment.

Cause

Liver nodular lesions can be divided into the following five categories: hepatic nodular regenerative hyperplasia, hepatic focal nodular hyperplasia, hepatic partial nodular changes, cirrhosis, hepatic adenoma.

Hepatic nodular regenerative hyperplasia:

The nodular regenerative hyperplasia of the liver (NRH) was reported by Strimyer and lshak in 1981 and is a rare disease. It used to be called liver nodular, miliary hepatoma, non-sclerosing liver nodules or non-sclerosing portal hypertension. Small hepatocyte nodules are diffusely distributed throughout the liver, surrounded by no fibrous tissue around the nodules, with little or no fibrosis, which can be distinguished from cirrhosis. The disease often occurs in elderly patients, and childhood is extremely rare. The literature reports that the disease is often associated with other diseases, such as rheumatoid arthritis, Felty syndrome, kidney transplantation, Crohn's disease and blood diseases, drugs (such as immunosuppressive agents, corticosteroids), and adulterated cooking oil. The resulting toxic oil syndrome and the like. The cause of the disease is unknown, and may be related to the abnormal healing response of the liver to the damage. Abdominal masses are a common clinical manifestation, and intrahepatic portal hypertension may occur, suggesting that the nodules cause distortion of the intrahepatic vessels. Liver function is normal, no jaundice, ascites, hypoproteinemia, prolonged prothrombin time. Not accompanied by chronic hepatitis B virus infection or cirrhosis. In cases without comorbidities, the alpha-fetoprotein concentration is in the normal range. Fine needle aspiration biopsy is not useful for diagnosis, and surgical liver margin biopsy is helpful for diagnosis. The prognosis is generally good, but hepatocyte developmental disorders can occur, and there have been reports of individual progression to hepatocellular carcinoma.

Liver focal nodular hyperplasia:

Focal nodular hyperplasia of the liver

Liver; FNH), reported by Rogers in 1981, is a rare benign lesion that was previously named focal sclerosis, focal nodular sclerosis, isolated hyperplastic nodules, or isolated nodular regenerative hyperplasia. The disease can occur at any age, and women are common (80%).

The cause of this disease is unknown. It is generally believed that on the basis of congenital vascular malformation, the cells are susceptible to stimulating by hormone drugs due to defects in the hepatocyte enzyme system, resulting in repair and regeneration after necrosis. It may also be an abnormal regenerative response to vascular liver damage. Many reports suggest that the disease is related to oral contraceptives, and that contraceptives may have a nutritional effect on focal nodular proliferating cells of the liver. Women with oral contraceptives are prone to focal hepatic nodular hyperplasia and hemorrhage, a few cases. The focal nodular hyperplasia of the liver shrinks after stopping the contraceptive or estrogen.

FNH is usually a single nodule, located under the liver capsule, a small number of multiple nodules, located in the deep part of the liver. The nodules are small, 1-7cm in diameter, with clear boundaries but no envelope, yellow-brown, and hard texture. The center of the nodule section is a star-shaped scar tissue, which is separated from the central to the surrounding to separate the nodules. It is a characteristic change of focal nodular hyperplasia of the liver. Sometimes the central scar is not obvious, and a thin intricate fiber layer is seen. Microscopically, the normal structure of the liver is destroyed. The central star-shaped scar tissue contains one or several arteries. The arterial intima or the middle fibromuscular layer often has abnormal hyperplasia, which narrows or locks the lumen, without a central vein. Fibrous spaces of varying sizes radiate from the central scar tissue to the periphery, and the fibrous septa consists of proliferating hepatocytes, sinusoids, and Kupffer cells. There may be bile duct hyperplasia and inflammatory cell infiltration in the nodules and between the nodules.

The disease is usually asymptomatic, and a small number of lesions may have upper abdominal discomfort or pain in the liver area. Intra-abdominal hemorrhage is a very rare complication. There is no characteristic serum marker for focal nodular hyperplasia of the liver, and its detection mainly depends on imaging examination. B-ultrasound, CT, MRI and other examinations can show the performance of uniform lesions, slightly lower density, central scar and clutch arterial blood flow.

For young patients without cirrhosis, normal liver function, HBsAg and AFP negative, especially in women with hepatic space-occupying lesions, the possibility of focal nodular hyperplasia of the liver should be considered, but it must be associated with hepatocellular carcinoma and hepatocytes. Adenoma and other phases are identified. A combination of multiple imaging studies can improve diagnostic accuracy. Diagnosis must rely on pathological examination, but needle biopsy is not recommended.

The disease has no tendency to malignant, and those with larger lesions may have the risk of rupture and bleeding. Diagnosis of asymptomatic focal nodular hyperplasia of the liver can closely observe changes in the lesion. If the lesion is enlarged or cannot be differentiated from hepatocellular carcinoma, surgical resection is feasible. If there is a surgical contraindication or can not be removed, arterial embolization can be treated.

Hepatic partial nodular phlegm:

Partial nodular transformation of the liver. Partial nodular changes in the liver, also known as nodule transformation, are also rare diseases. Nodules occur around the hilum and may cause portal hypertension. The rest of the liver tissue is normal or atrophic, and liver function is normal. Fine needle aspiration biopsy is not useful for diagnosis. The cause of this disease is unknown.

Cirrhosis:

Liver cirrhosis is a common chronic liver disease that can cause liver damage from one or more causes. The liver is progressive, diffuse, and fibrous. The specific manifestations are diffuse degeneration and necrosis of hepatocytes, followed by fibrous tissue hyperplasia and hepatocyte nodular regeneration. These three changes are repeatedly staggered. As a result, the hepatic lobular structure and blood circulation pathway are gradually reconstructed, causing the liver to deform and harden. Causes cirrhosis of the liver. There was no obvious symptom in the early stage of the disease, and a series of different degrees of portal hypertension and liver dysfunction occurred in the later stage until the upper gastrointestinal hemorrhage and hepatic encephalopathy died.

Hepatic adenoma:

Hepatic adenoma, also known as hepatocellular adenoma (HCA), is a rare benign tumor of the liver. There were few reports in the literature before the 1960s, but the increase in reports on hepatic adenomas in the future may be related to the increase in the use of contraceptives.

an examination

Related inspection

Liver function examination liver ultrasound examination

There are related medical history such as viral hepatitis or drinking, there are clinical manifestations of liver dysfunction and portal hypertension, liver texture is hard and nodular; liver function tests often have positive findings, and liver biopsy see pseudolobule formation.

Differential diagnosis

Mainly differentiated from hepatic adenoma, because the latter often have complications, tumors are easy to rupture and hemorrhage, often require surgical treatment, the main identification is based on pathological examination.

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