Early Nodular Hyperplasia of the Liver Occurring with Inflammatory Bowel Diseases in Association with Thioguanine Therapy

Context.-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. Objective.-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. Design.-Percutaneous liver biopsies and histologic examinations were performed, including staining with the reticulin silver impregnation method. Results.-All 3 patients had foci of nodular regenerative hyperplasia, which was best seen with the reticulin silver impregnation method. Conclusions.-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.