Early nodular hyperplasia of the liver occurring with inflammatory bowel diseases in association with thioguanine therapy.

Abstract

Nodular hyperplasia (also referred to as nodular regenerative hyperplasia and nodular regenerative hyperplasia of the liver) is a sequel to therapy with thioguanine in patients with hematologic malignancies. Recently, 6-thioguanine has been used to treat patients with inflammatory bowel disease who have been resistant to other forms of therapy. To study liver biopsies from 3 patients with inflammatory bowel disease who had received thioguanine for more than a year, and who had elevated serum liver enzyme values and underwent percutaneous liver biopsy. Percutaneous liver biopsies and histologic examinations were performed, including staining with the reticulin silver impregnation method. All 3 patients had foci of nodular regenerative hyperplasia, which was best seen with the reticulin silver impregnation method. Thioguanine-treated inflammatory bowel disease patients are at risk for the development of nodular hyperplasia. Reticulin-stained histologic sections are necessary to recognize this change. Further studies are needed to determine the frequency and significance of this change.