Wanless I R, Mawdsley C, Adams R
Hepatology. 1985 Nov-Dec;5(6):1194-200. doi: 10.1002/hep.1840050622.
Fifty-one focal nodular hyperplasia lesions from 36 patients were examined histologically. Serial sections and three-dimensional models were studied in selected cases. Lesions were multiple in 19% of patients. Thirty-four patients were female. One case had 11 focal nodular hyperplasia lesions and 7 hemangiomata in the liver. Three had astrocytoma and one had anomalous pulmonary venous drainage. Morphometric analysis revealed that the lesions were supplied by an anomalous artery larger than expected for the locale in the liver. This artery branched to form a spider-like structure and was usually not accompanied by a portal vein or duct. Each terminal arterial branch supplied a separate nodule 1 mm in diameter; adjacent nodules coalesced to form the focal nodular hyperplasia lesion. The arterial blood appeared to drain directly into the sinusoids of the nodule. We propose that focal nodular hyperplasia is an hyperplastic response of the hepatic parenchyma to a preexisting arterial spider-like malformation. The frequent coexistence of focal nodular hyperplasia with other vascular and neuroendocrine anomalies suggest that the malformations are developmental in origin. The basic requirement for development of hepatic hyperplasia may be greater blood flow to a region compared to the adjacent parenchyma. This requirement appears to be met in the other forms of nodular transformation of the liver, i.e., nodular regenerative hyperplasia and partial nodular transformation.
对36例患者的51个局灶性结节性增生病变进行了组织学检查。对部分病例进行了连续切片和三维模型研究。19%的患者病变为多发。34例为女性。1例患者肝脏有11个局灶性结节性增生病变和7个血管瘤。3例有星形细胞瘤，1例有肺静脉引流异常。形态学分析显示，病变由一条比肝脏局部预期更大的异常动脉供血。该动脉分支形成蜘蛛样结构，通常不伴有门静脉或胆管。每个终末动脉分支供应一个直径1mm的独立结节；相邻结节融合形成局灶性结节性增生病变。动脉血似乎直接排入结节的血窦。我们认为局灶性结节性增生是肝实质对先前存在的动脉蜘蛛样畸形的增生反应。局灶性结节性增生与其他血管和神经内分泌异常的频繁共存提示这些畸形起源于发育过程。肝增生发展的基本条件可能是与相邻实质相比，某一区域有更多的血流。在肝脏的其他结节性转化形式，即结节性再生性增生和部分结节性转化中，这一条件似乎也得到了满足。
