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In one study of patients who were followed by magnetic resonance imaging (MRI) after transplant to assess liver iron stores, the cumulative incidence of FNH was 35% at 150 months posttransplant.[49] FNH can mimic metastatic or subsequent tumors, but MRI imaging has a characteristic pattern and is generally diagnostic.[49] Biopsy or resection is usually unnecessary unless the lesions grow or patients have worrisome symptoms.[49] Nodular regenerative hyperplasia Nodular regenerative hyperplasia is a rare condition characterized by the development of multiple monoacinar regenerative hepatic nodules and mild fibrosis.[45] The pathogenesis of nodular regenerative hyperplasia is not well established but may represent a nonspecific tissue adaptation to heterogeneous hepatic blood flow.[51] Nodular regenerative hyperplasia has rarely been observed in survivors of childhood cancer treated with chemotherapy, with or without liver irradiation.[52,53] Biopsy may be necessary to distinguish nodular regenerative hyperplasia from a subsequent malignancy.[53] Microvesicular fatty change Histological evidence of fatty infiltration (93%) and siderosis (up to 70%) was observed in children with acute lymphoblastic leukemia (ALL) who recently completed intensified therapy

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