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Incidence of adenomatous hyperplasia in postmortem cirrhotic livers and study of cellular proliferative indices by light microscopy.

BACKGROUND
Adenomatous hyperplasia (AH) or dysplastic nodule in the liver is considered a preneoplastic lesion. A wide range in its incidence has been reported.


AIMS
To study the incidence of AH nodules in autopsy cirrhotic livers and to carry out a comparative study of the cellular proliferative indices.


MATERIALS
Retrospective study of 150 cases with cirrhosis of variable etiology at autopsy, over a 15-year period.


METHODS
We identified AH on gross examination and studied the morphology. We compared cellular proliferative indices in AH nodules with other liver nodules by using PCNA monoclonal antibody and AgNOR.


RESULTS
Alcohol was the commonest etiology (30%), followed by HBsAg positivity (38%). Most patients belonged to the 30-60 years age group, with male predominance. Sixty of the 150 livers showed AH nodules; there were one to four nodules, measuring 6 mm to 50 mm, per liver. 115/122 AH nodules were studied. Ordinary AH (OAH) was seen in 104 and atypical AH (AAH) in 11, with malignant focus (MF) in four. Associated hepatocellular carcinoma (HCC) was seen in 7 cases. A gradual increase in the proliferative indices from surrounding regenerating nodules (SRN) and OAH to AAH to AAH with MF to HCC was observed. In addition, AAH also showed relatively less reticulin fibers.


CONCLUSION
The incidence of AH was 40%. In addition to the cellular proliferative indices, relatively less reticulin fibers could be a distinguishing feature for AAH from SRN, OAH and HCC.