Fig. 8: Proposed mechanism of FNH development: local hyperoxygenation and oxidative stress induce senescence in hepatocytes and cholangiocytes.

Transdifferentiation of hepatocytes to cholangiocytes may occur in combination with K7 expression and ductular metaplasia. The SASP responsible for fibrosis and inflammation while inhibiting apoptosis is leading to increased tissue volume observed in FNH, without necessitating increased proliferation.