Liver and intrahepatic bile ducts - Tumor
Dysplasia
High grade dysplastic nodule

Author: Naziheh Assarzadegan, M.D. (see Authors page)
Editor: Raul S. Gonzalez, M.D.

Revised: 21 December 2016, last major update December 2016

Copyright: (c) 2004-2016, PathologyOutlines.com, Inc.

PubMed search: high grade "dysplastic nodule" liver

Cite this page: High grade dysplastic nodule. PathologyOutlines.com website. http://pathologyoutlines.com/topic/livertumorhighgradedysplasticnod.html. Accessed September 24th, 2017.
Definition / general
  • Discrete nodules in cirrhotic livers, containing high grade architectural and cytologic changes insufficient for a diagnosis of carcinoma (Hepatology 2009;49:658)
Essential features
  • Dysplastic nodules (both low grade and high grade) are associated with higher risk of development of hepatocellular carcinoma
  • High grade dysplastic nodules have a higher risk of transformation into hepatocellular carcinoma than low grade nodules (J Hepatol 2003;39:208) and themselves show molecular changes similar to carcinoma
Terminology
  • Also called borderline nodule, macroregenerative nodule type II, atypical macroregenerative nodule, atypical adenomatous hyperplasia
Clinical features
  • Considered a precursor to hepatocellular carcinoma
  • Usually increase in size over time and do not regress
Radiology description
  • Reduced portal blood flow in the nodule on computed tomography is an important predictor for development of hepatocellular carcinoma (Cancer 2006;106:636)
  • Usually isovascular or hypovascular compared to surrounding parenchyma, whereas hepatocellular carcinoma appears hypervascular
Treatment
  • Ablation or resection should be strongly considered
Gross description
  • Often vaguely nodular; can be a distinct nodule often in the background of cirrhosis
  • Lack a true capsule
  • Typically about 1 cm; can be single or multiple
Gross images
Images hosted on other servers:

High grade dysplastic
nodule, along with other
nodule types and carcinoma

Microscopic (histologic) description
  • Increased cellularity (more than 2 times higher than the adjacent nontumoral liver), often with an irregular trabecular pattern
  • Cytologic atypia is usually small cell change; large cell change may or may not be seen (Arch Pathol Lab Med 2011;135:704)
  • Portal tracts can be present within the nodules
  • Unpaired arteries can be present, but not in great numbers (Dig Liver Dis 2011;43:S361)
  • "Nodule in nodule" appearance may be seen, where the larger nodule is a high grade dysplastic nodule and the inside subnodule is usually a well differentiated hepatocellular carcinoma
Microscopic (histologic) images
Images hosted on other servers:

Increased cellularity (C, D)

Trabecular pattern and small cell change (E)

Atypia (D)

Increased cellularity and unpaired arteries (B)

Molecular / cytogenetics description
  • Telomere shortening, increased telomerase activity and strong expression of hTERT mRNA at levels similar to hepatocellular carcinoma (Hepatology 2014;60:1983)
  • Inactivation of p21, in contrast to cirrhotic nodules, which show activation (Mod Pathol 2009;22:1121)
Differential diagnosis