World Journal of Pathology Volume No 10

Original Article Open Access

Nodular Regenerative Hyperplasia and sinusoidal hepatic lesions in oxaliplatin based chemotherapy

Pablo Azcue, María Mercado, Irene Amat, Arkaitz Galbete and . Luisa M Gomez-Dorronsoro
World Journal of Pathology 2020, 9:2



Nodular Regenerative Hyperplasia (NRH), Sinusoidal Obstruction Syndrome (SOS) and Sinusoidal Dilatation (SD) are the most recognized patterns of drug-induced liver injury secondary to oxaliplatin based regimens in colorectal liver metastases (CRLM). The use of different combinations in chemotherapy treatments, an incidence reported for NRH that ranges between 4.8% and 15%, and a considerable variability for other vascular lesions, makes the evaluation a challenge.

Study Design

A historic prospective maintained database cohort of 160 tissue samples of CRLM.


The aim of this study is to evaluate the incidence of vascular hepatic lesions (SD, SOS and NRH) due to oxaliplatin based regimens. Additionally, it details a series of seven cases of NHR, its relationship with other vascular alterations, type of treatment and the presence or not of blue liver syndrome.


Univariate analysis showed association between preoperative use of oxaliplatin with or without biological agents and developing SD (p&0.05). Notably, the use of 5-FU was also found to increase the risk of SD. Multivariate analysis confirmed the association between oxaliplatin and developing SD (p=0.021). All seven cases of NRH (incidence of 6%) were treated with FOLFOX regimen with at least 6 cycles. These cases presented severe SD and diagnosis of SOS and represented 31.8% of all patients with SOS.


Oxaliplatin based chemotherapies regimens are associated with SD, SOS, NRH and blue liver syndrome. These vascular alterations seem to be part of an evolutionary process. The role of 5-FU although not extensively studied, could act as a synergic factor.

Key Words

Nodular Regenerative Hyperplasia, Sinusoidal Obstruction Syndrome, Sinusoidal Dilatation, Colorectal liver metastasis, oxaliplatin

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