A Case of Nodular Regenerative Hyperplasia in a Patient with Hepatic Carcinoid

Atsushi Muraoka, Nobuyuki Watanabe, Yoshihiro Ikeda, Gotaro Katsuno, Yasutaka Kokudo, Akihiko Tatemoto, Shigeo Kagawa, Makoto Tsumura and Masaki Tsuruno

Department of Surgery, Kagawa Rosai Hospital

We report nodular regenerative hyperplasia (NRH) in a patient with solitary hepatic carcinoid. A 37-year-old woman admitted for a large hepatic tumor detected by ultrasonography screening, was otherwise well and blood analyses, including tumor and viral markers, were normal. Computed tomography, magnet resonance imaging and angiography showed a large cystic hepatic tumor with multiple small nodules suggesting malignancy with multiple intrahepatic metastases. Surgery was conducted to prevent tumor perforation and to resolve discrepancies in preoperative diagnosis. Intraoperative wedge biopsy showed the small nodules to be benign. We conducted a right liver lobectomy, although some nodules remained in the remnant left lobe. Histologically, the main tumor was diagnosed as carcinoid, and the multiple small nodules as NRH. Histological findings of sinusoidal dilation and abnormal vessel formation, and the fact that remnant nodules in the left lobe disappeared postoperatively, suggest that nodule formation depended on intrahepatic hemodynamics. Careful preoperative examination, surgical exploration, and postoperative examination over 4 years found no other primary carcinoid site, confirming the dignosis of primary hepatic carcinoid tumor.

Key words
hepatic carcinoid, nodular regenerative hyperplasia

Reprint requests
Atsushi Muraoka Department of Surgery, Kagawa Rosai Hospital 3-3-1 Jyoto-cho, Marugame, 763-0013 JAPAN

Accepted
September 25, 2002

To read the PDF file you will need Abobe Reader installed on your computer.