Nodular hyperplasia of the liver with portal hypertension and diabetes mellitus: —A Case Report—

In June 1982, a 52-year-old Japanese woman was admitted to the hospital with a 1-year history of weight loss and thirst. She had never taken oral contraceptive or other steroids. Physical examination revealed an elastic hard, nodular liver 4.5 cm below the xiphisternum. Laboratory tests revealed leukocytopenia, thrombocytopenia, and elevated levels of serum alkaline-phosphatase, LAP, γ-GTP, GOT, GPT and fasting glucose. Splenomegaly and nodular lesion of the liver were suspected by image analyses, and a selective celiac arteriogram revealed hypovascular tumors associated with displacement of hepatic arteries and their branches. In November 1982, splenectomy with esophageal resection and devascularization was performed due to esophageal and gastric varices. At operation the liver surface showed multiple nodules of various sizes. Wedge liver biopsy revealed the tumors consisted of small nodules with indistinct boundaries. In nodular areas hepatocytic plates were irregularly arranged and individual hepatocytes were of relatively small and pale cytoplasm, but atypia of nucleus was not noted. In surrounding parenchyma both compressed and dilated vessels were recognized. It was suggested that compression of intrahepatic vasculature by the multiple nodules was an important factor in the pathogenesis of portal hypertension in the present case.