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Abstract
Hepatocellular adenoma (HCA) is a rare and benign liver tumor that affects predominantly young and middle-aged women, especially between 30–40 years old. Liver adenomatosis (LA) is defined as the presence of 10 or more HCA. There are authors that report eight different subtypes of HCA, that correlates with clinical and histopathological features, being the inflammatory subtype the most common. We present a case of a 32-year-old Caucasian woman with a history of self-limited episodes of right abdominal pain and an abdominal ultrasound with multiple hypoechogenic liver nodules, suspected of metastasis. She was taking combined oral contraceptive for 6 years. Magnetic Resonance Imaging (MRI) disclosed around 40 nodules, suggestive of HCA. Liver biopsy confirmed HCA, inflammatory subtype. Oral contraceptive was stopped and control MRI 6 months later disclosed reduction of nodules’ dimensions. Management of patients with LA should be based on the size of the largest tumor, as clinical presentation and risk of bleeding or malignancy do not differ between patients with single or multiple HCAs. However, even with biopsy, there is a risk of missampling, raising concern about the real risk of bleeding and malignant potential in patients with different subtypes coexisting in the same liver.
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van Rosmalen BV, Furumaya A, Klompenhouwer AJ, Tushuizen ME, Braat AE, Reinten RJ, Ligthart MAP, Haring MPD, de Meijer VE, van Voorthuizen T, Takkenberg RB, Dejong CHC, de Man RA, IJzermans JNM, Doukas M, van Gulik TM, Verheij J. Hepatocellular adenoma in men: A nationwide assessment of pathology and correlation with clinical course. Liver Int 2021; 41:2474-2484. [PMID: 34155783 PMCID: PMC8518832 DOI: 10.1111/liv.14989] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/27/2021] [Accepted: 06/05/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Hepatocellular adenomas (HCA) rarely occur in males, and if so, are frequently associated with malignant transformation. Guidelines are based on small numbers of patients and advise resection of HCA in male patients, irrespective of size or subtype. This nationwide retrospective cohort study is the largest series of HCA in men correlating (immuno)histopathological and molecular findings with the clinical course. METHODS Dutch male patients with available histological slides with a (differential) diagnosis of HCA between 2000 and 2017 were identified through the Dutch Pathology Registry (PALGA). Histopathology and immunohistochemistry according to international guidelines were revised by two expert hepatopathologists. Next generation sequencing (NGS) was performed to confirm hepatocellular carcinoma (HCC) and/or subtype HCA. Final pathological diagnosis was correlated with recurrence, metastasis and death. RESULTS A total of 66 patients from 26 centres fulfilling the inclusion criteria with a mean (±SD) age of 45.0 ± 21.6 years were included. The diagnosis was changed after expert revision and NGS in 33 of the 66 patients (50%). After a median follow-up of 9.6 years, tumour-related mortality of patients with accessible clinical data was 1/18 (5.6%) in HCA, 5/14 (35.7%) in uncertain HCA/HCC and 4/9 (44.4%) in the HCC groups (P = .031). Four B-catenin mutated HCA were identified using NGS, which were not yet identified by immunohistochemistry and expert revision. CONCLUSIONS Expert revision with relevant immunohistochemistry may help the challenging but prognostically relevant distinction between HCA and well-differentiated HCC in male patients. NGS may be more important to subtype HCA than indicated in present guidelines.
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Affiliation(s)
- Belle V. van Rosmalen
- Department of SurgeryCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Alicia Furumaya
- Department of SurgeryCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Anne J. Klompenhouwer
- Department of Gastroenterology and HepatologyErasmus MCUniversity Medical Center RotterdamRotterdamthe Netherlands
| | - Maarten E. Tushuizen
- Department of Gastroenterology and HepatologyLUMCLeiden UniversityLeidenthe Netherlands
| | | | - Roy J. Reinten
- Department of PathologyCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Marjolein A. P. Ligthart
- Department of Surgery and School of Nutrition and Translational Research in MetabolismMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Martijn P. D. Haring
- Department of SurgeryUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Vincent E. de Meijer
- Department of SurgeryUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | | | - R. Bart Takkenberg
- Department of Gastroenterology and HepatologyCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Cornelis H. C. Dejong
- Department of Surgery and School of Nutrition and Translational Research in MetabolismMaastricht University Medical CenterMaastrichtthe Netherlands,Department of SurgeryUniversitätsklinikum AachenAachenGermany
| | - Robert A. de Man
- Department of Gastroenterology and HepatologyErasmus MCUniversity Medical Center RotterdamRotterdamthe Netherlands
| | - Jan N. M. IJzermans
- Department of SurgeryErasmus MCUniversity Medical Center RotterdamRotterdamthe Netherlands
| | - Michail Doukas
- Department of PathologyErasmus MCUniversity Medical Center RotterdamRotterdamthe Netherlands
| | - Thomas M. van Gulik
- Department of SurgeryCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Joanne Verheij
- Department of PathologyCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
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Haring MPD, Gouw ASH, de Haas RJ, Cuperus FJC, de Jong KP, de Meijer VE. The effect of oral contraceptive pill cessation on hepatocellular adenoma diameter: A retrospective cohort study. Liver Int 2019; 39:905-913. [PMID: 30773766 PMCID: PMC6593966 DOI: 10.1111/liv.14074] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 01/24/2019] [Accepted: 01/30/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS Hepatocellular adenomas (HCA) are rare, hormone-driven, benign liver tumours. HCA >50 mm are associated with haemorrhage and malignant transformation. Guidelines recommend cessation of oral contraceptive pills (OCP) for size reduction; however, it is currently unknown how HCA respond to cessation of OCP. We sought to investigate the effect of OCP cessation on HCA size. METHODS A retrospective cohort study was performed including HCA patients who stopped OCP intake within 6 months of imaging between 2005 and 2018. Biometrics and hormonal medication use were evaluated with self-designed questionnaires. Response of the largest HCA was evaluated according to Response Evaluation Criteria in Solid Tumours (RECISTv1.1). Cox regression was performed for analysis of factors influencing HCA regression. RESULTS Seventy-eight HCA patients were included, diagnosed at a median (interquartile range) age of 32 (26-41) years. Follow-up was 1.6 (0.4-2.9) years. HCA size at diagnosis ranged 10-167 mm. After a median time of 1.3 (0.6-2.6) years after OCP cessation, 37.2% of HCA showed ≥30% regression, 5.1% complete regression, 56.4% stability and 1.3% progression. No HCA-induced complications were observed during follow-up. Cox regression analysis demonstrated a significant association of HCA size with rate of regression; 50 ≤ HCA < 100 mm (HR 2.4, 95% CI 1.1-5.3; P < 0.05), HCA ≥ 100 mm (HR 8.3, 95% CI 3.3-21.6; P < 0.001). CONCLUSIONS Ninety-eight per cent of HCA remained stable or regressed after OCP cessation. A longer wait-and-see period was associated with a larger proportion of regressing HCA, without HCA-related complications during follow-up.
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Affiliation(s)
- Martijn P. D. Haring
- Department of Hepatopancreatobiliary Surgery and Liver TransplantationUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Annette S. H. Gouw
- Department of PathologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Robbert J. de Haas
- Department of RadiologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Frans J. C. Cuperus
- Department of HepatologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Koert P. de Jong
- Department of Hepatopancreatobiliary Surgery and Liver TransplantationUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Vincent E. de Meijer
- Department of Hepatopancreatobiliary Surgery and Liver TransplantationUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
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Abstract
Correlation between androgen use and hepatocellular neoplasia is well established. However, there are no detailed studies of the histopathology and immunohistochemical/molecular profile of these tumors. We studied 9 patients with androgen-associated hepatocellular neoplasms. In addition to histology, immunostains for liver fatty acid-binding protein, β-catenin, glutamine synthetase, C-reactive protein, and serum amyloid A were utilized for tumor subtyping. Molecular testing using Solid Tumor Targeted Cancer Panel was performed on 3 cases. The neoplasms were predominantly seen in male individuals (7/9). Two patients (22%) had multifocal lesions. All lesions had architectural and 4/9 had cytologic atypia. Cholestasis was present in 6/9 cases. Reticulin was focally disrupted in 5/9 cases. Given the clinical setting, all lesions were classified as well-differentiated hepatocellular neoplasms of uncertain malignant potential. In cases with follow-up (6/9 cases, 67%), there were no recurrences or metastases. On the basis of the immunoprofile, 7 (78%) cases were β-catenin activated (including 1 hepatic adenoma with concurrent hepatocyte nuclear factor 1α inactivation) and 2 (22%) had inflammatory phenotype. Somatic mutations in CTNNB1 were detected in all 3 tested cases (all β-catenin activated by immunostain), all involving exon-3. Our data indicate that androgen-associated hepatocellular neoplasms most often develop in male individuals and always show some degree of atypia and/or focal reticulin disruption. Most are β-catenin activated, often harboring CTNNB1 exon-3 mutations, and a minority is inflammatory type. Although β-catenin and inflammatory pathways likely play a role in pathogenesis, the heterogenous molecular profile suggests there are other (yet to be characterized) primary oncogenic mechanisms in this unique tumor type.
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EASL Clinical Practice Guidelines on the management of benign liver tumours. J Hepatol 2016; 65:386-98. [PMID: 27085809 DOI: 10.1016/j.jhep.2016.04.001] [Citation(s) in RCA: 284] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 04/05/2016] [Indexed: 02/06/2023]
Affiliation(s)
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- European Association for the Study of the Liver (EASL), The EASL Building – Home of European Hepatology, 7 rue Daubin, CH 1203 Geneva, Switzerland.
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Shih A, Lauwers GY, Balabaud C, Bioulac-Sage P, Misdraji J. Simultaneous occurrence of focal nodular hyperplasia and HNF1A-inactivated hepatocellular adenoma: a collision tumor simulating a composite FNH-HCA. Am J Surg Pathol 2015; 39:1296-300. [PMID: 26274031 DOI: 10.1097/pas.0000000000000477] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Mixed focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) within a single tumor mass is rarely reported, and most of these cases are examples of tumors with features intermediate between FNH and HCA. Although a few reported cases are probably examples of true mixed tumors, none was evaluated immunohistochemically or confirmed by molecular analysis. We report a mixed FNH and HCA arising in a woman with several HNF1A-inactivated adenomas. Our case is the first case of mixed FNH and HNF1A-inactivated HCA documented by immunohistochemistry.
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Affiliation(s)
- Angela Shih
- *James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Harvard Medical School, Boston, MA †Inserm U1053, Université de Bordeaux ‡Pathology Department, Pellegrin Hospital, CHU Bordeaux, Bordeaux, France
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Cazorla A, Félix S, Valmary-Degano S, Sailley N, Thévenot T, Heyd B, Bioulac-Sage P. Polycystic ovary syndrome as a rare association with inflammatory hepatocellular adenoma: a case report. Clin Res Hepatol Gastroenterol 2014; 38:e107-10. [PMID: 24994518 DOI: 10.1016/j.clinre.2014.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 04/15/2014] [Accepted: 05/05/2014] [Indexed: 02/04/2023]
Abstract
Hormonal factors, like oral contraceptives, create a predisposition to hepatocellular adenoma. We present the case of a young woman with an inflammatory hepatocellular adenoma occurring in the context of a polycystic ovary syndrome. In view of this possible relationship, it would be recommended to follow up patients with hyperandrogenism with repeated liver tests and ultrasonographics. Furthermore, this observation illustrated some difficulties to differentiate remodelled inflammatory hepatocellular adenoma and focal nodular hyperplasia and underlined the interest of immunohistochemical markers for the right diagnosis.
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Affiliation(s)
| | - Sophie Félix
- Department of Pathology, CHU de Besançon, Besancon, France
| | - Séverine Valmary-Degano
- Department of Pathology, CHU de Besançon, Besancon, France; University of Franche-Comte, Besancon, France
| | - Nicolas Sailley
- University of Franche-Comte, Besancon, France; Department of Radiology, CHRU Jean-Minjoz, Besancon, France
| | - Thierry Thévenot
- University of Franche-Comte, Besancon, France; Department of Hepatology, CHRU Jean-Minjoz, Besancon, France
| | - Bruno Heyd
- University of Franche-Comte, Besancon, France; Department of Digestive Surgery, CHRU Jean-Minjoz, Besancon, France
| | - Paulette Bioulac-Sage
- Inserm U1053, Bordeaux University, Bordeaux, France; Department of Pathology, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France
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Dhingra S, Fiel MI. Update on the new classification of hepatic adenomas: clinical, molecular, and pathologic characteristics. Arch Pathol Lab Med 2014; 138:1090-7. [PMID: 25076298 DOI: 10.5858/arpa.2013-0183-ra] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
CONTEXT Hepatic adenoma is an uncommon, benign, hepatic neoplasm that typically occurs in women of child-bearing age, often with a history of long-term use of oral contraceptive drugs. This is usually detected as an incidental mass lesion in a noncirrhotic liver during imaging studies. Pathologic evaluation by needle core biopsy remains the gold standard for diagnosis. Molecular studies have revealed that hepatic adenomas involve unique molecular pathways that are distinct from hepatocellular carcinoma. Based on these studies, a French collaborative group has recently proposed a molecular-pathologic classification for hepatic adenomas. In addition, advances in molecular studies have led to reclassification of the "telangiectatic variant of focal nodular hyperplasia" as "hepatic adenoma, inflammatory subtype." OBJECTIVE To review the proposed, new classification of hepatic adenoma and the changes in diagnostic workup in light of the above-mentioned developments. DATA SOURCES Review of published literature and illustrations from clinical case material. CONCLUSIONS Definitive diagnosis of liver mass lesion on needle core biopsies has a decisive role in clinical management. With the advent of the new classification of hepatic adenomas and its prognostic implications, it is vital for pathologists to be aware of the morphologic features seen in different subtypes and the available diagnostic tools, such as immunohistochemistry, to help identify the correct subtype.
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Affiliation(s)
- Sadhna Dhingra
- From the Lillian and Henry M. Stratton-Hans Popper Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
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Dimitroulis D, Lainas P, Charalampoudis P, Karatzas T, Delladetsima I, Sakellariou S, Karidis N, Kouraklis G. Co-existence of hepatocellular adenoma and focal nodular hyperplasia in a young female. World J Hepatol 2012; 4:314-8. [PMID: 23293718 PMCID: PMC3536839 DOI: 10.4254/wjh.v4.i11.314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 12/14/2011] [Accepted: 10/22/2012] [Indexed: 02/06/2023] Open
Abstract
Focal nodular hyperplasia (FNH) and hepatocellular adenoma (HA) are both benign hepatocellular lesions, presenting mainly in women of childbearing age in non-cirrhotic, non-fibrotic livers. Simultaneous occurrence of these two lesions is extremely rare. We herein report a case of a young female without any predisposing risk factors who presented to our emergency department complaining of acute abdominal pain. Imaging studies revealed a 6 cm lesion in the right hepatic lobe and a 2.5 cm lesion in the left hepatic lobe, respectively. In view of the patient's symptoms and lack of a confirmed diagnosis based on imaging, we performed a bisegmentectomy V-VI and a wedge resection of the lesion in segment III by laparotomy. Postoperative course was uneventful and the patient was discharged on the fourth postoperative day. The pathology report demonstrated an HA in segments V-VI and FNH in segment III, respectively. Six months later, the patient remains asymptomatic with normal liver function tests, ultrasound and magnetic resonance imaging follow-up. To our best knowledge, this is the first case to describe simultaneous occurrence of HA and FNH without the presence of any known risk factors for these entities. The uncertainty in diagnosis and acuteness of presenting symptoms were established criteria for prompt surgical intervention.
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Affiliation(s)
- Dimitrios Dimitroulis
- Dimitrios Dimitroulis, Panagiotis Lainas, Petros Charalampoudis, Theodore Karatzas, Nikolaos Karidis, Gregory Kouraklis, 2nd Department of General Surgery, Laiko Hospital, University of Athens Medical School, 11527 Athens, Greece
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Judson RS, Houck KA, Kavlock RJ, Knudsen TB, Martin MT, Mortensen HM, Reif DM, Rotroff DM, Shah I, Richard AM, Dix DJ. In vitro screening of environmental chemicals for targeted testing prioritization: the ToxCast project. ENVIRONMENTAL HEALTH PERSPECTIVES 2010; 118:485-92. [PMID: 20368123 PMCID: PMC2854724 DOI: 10.1289/ehp.0901392] [Citation(s) in RCA: 396] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 12/14/2009] [Indexed: 05/18/2023]
Abstract
BACKGROUND Chemical toxicity testing is being transformed by advances in biology and computer modeling, concerns over animal use, and the thousands of environmental chemicals lacking toxicity data. The U.S. Environmental Protection Agency's ToxCast program aims to address these concerns by screening and prioritizing chemicals for potential human toxicity using in vitro assays and in silico approaches. OBJECTIVES This project aims to evaluate the use of in vitro assays for understanding the types of molecular and pathway perturbations caused by environmental chemicals and to build initial prioritization models of in vivo toxicity. METHODS We tested 309 mostly pesticide active chemicals in 467 assays across nine technologies, including high-throughput cell-free assays and cell-based assays, in multiple human primary cells and cell lines plus rat primary hepatocytes. Both individual and composite scores for effects on genes and pathways were analyzed. RESULTS Chemicals displayed a broad spectrum of activity at the molecular and pathway levels. We saw many expected interactions, including endocrine and xenobiotic metabolism enzyme activity. Chemicals ranged in promiscuity across pathways, from no activity to affecting dozens of pathways. We found a statistically significant inverse association between the number of pathways perturbed by a chemical at low in vitro concentrations and the lowest in vivo dose at which a chemical causes toxicity. We also found associations between a small set of in vitro assays and rodent liver lesion formation. CONCLUSIONS This approach promises to provide meaningful data on the thousands of untested environmental chemicals and to guide targeted testing of environmental contaminants.
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Affiliation(s)
- Richard S Judson
- National Center for Computational Toxicology, Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA.
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11
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Venturi A, Piscaglia F, Vidili G, Flori S, Righini R, Golfieri R, Bolondi L. Diagnosis and management of hepatic focal nodular hyperplasia. J Ultrasound 2007; 10:116-27. [PMID: 23396642 PMCID: PMC3478711 DOI: 10.1016/j.jus.2007.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Focal nodular hyperplasia (FNH) is the second most common benign tumor of the liver, after hemangioma. It is generally found incidentally and is most common in reproductive-aged women, but it also affects males and can be diagnosed at any age. Patients are rarely symptomatic, but FNH sometimes causes epigastric or right upper quadrant pain. The main clinical task is to differentiate it from other hypervascular hepatic lesions such as hepatic adenoma, hepatocellular carcinoma, or hypervascular metastases, but invasive diagnostic procedures can generally be avoided with the appropriate use of imaging techniques. Magnetic resonance (MR) imaging is more sensitive and specific than conventional ultrasonography (US) or computed tomography (CT), but Doppler US and contrast-enhanced US (CEUS) can greatly improve the accuracy in the diagnosis of FNH. Once a correct diagnosis has been made, in most cases there is no indication for surgery, and treatment includes conservative clinical follow-up in asymptomatic patients.
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Affiliation(s)
- A. Venturi
- Department of Internal Medicine and Gastroenterology, Policlinico St. Orsola-Malpighi, University of Bologna, Italy
| | - F. Piscaglia
- Department of Internal Medicine and Gastroenterology, Policlinico St. Orsola-Malpighi, University of Bologna, Italy
| | - G. Vidili
- Department of Internal Medicine and Gastroenterology, Policlinico St. Orsola-Malpighi, University of Bologna, Italy
| | - S. Flori
- Department of Internal Medicine and Gastroenterology, Policlinico St. Orsola-Malpighi, University of Bologna, Italy
| | - R. Righini
- Department of Internal Medicine and Gastroenterology, Policlinico St. Orsola-Malpighi, University of Bologna, Italy
| | - R. Golfieri
- Department of Radiology, Policlinico St. Orsola-Malpighi, University of Bologna, Italy
| | - L. Bolondi
- Department of Internal Medicine and Gastroenterology, Policlinico St. Orsola-Malpighi, University of Bologna, Italy
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Triantafyllopoulou M, Whitington PF, Melin-Aldana H, Benya EC, Brickman W. Hepatic adenoma in an adolescent with elevated androgen levels. J Pediatr Gastroenterol Nutr 2007; 44:640-2. [PMID: 17460501 DOI: 10.1097/mpg.0b013e31802e9a4a] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Maria Triantafyllopoulou
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Memorial Hospital, Northwestern University, Chicago, Illinois 60614, USA.
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13
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Petsas T, Tsamandas A, Tsota I, Karavias D, Karatza C, Vassiliou V, Kardamakis D. A case of hepatocellular carcinoma arising within large focal nodular hyperplasia with review of the literature. World J Gastroenterol 2006; 12:6567-71. [PMID: 17072995 PMCID: PMC4100652 DOI: 10.3748/wjg.v12.i40.6567] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Focal nodular hyperplasia (FNH) is a relatively rare benign hepatic tumor, usually presenting as a solitary lesion; however, multiple localizations have also been described. The association of FNH with other hepatic lesions, such as adenomas and haemangiomas has been reported by various authors. We herein report a case of a hepatocellular carcinoma arising within a large focal nodular hyperplasia, in a young female patient.
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Affiliation(s)
- Theodoros Petsas
- Department of Radiology, University of Patras Medical School, 26500 Rion, Greece
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14
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Gong L, Su Q, Zhang W, Li AN, Zhu SJ, Feng YM. Liver cell adenoma: A case report with clonal analysis and literature review. World J Gastroenterol 2006; 12:2125-9. [PMID: 16610069 PMCID: PMC4087697 DOI: 10.3748/wjg.v12.i13.2125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We report a case of liver cell adenoma (LCA) in a 33-year-old female patient with special respect to its clonality status, pathogenic factors and differential diagnosis. The case was examined by histopathology, immunohistochemistry and a clonality assay based on X-chromosomal inactivation mosaicism in female somatic tissues and polymorphism at androgen receptor focus. The clinicopathological features of the reported cases from China and other countries were compared. The lesion was spherical, sizing 2 cm in its maximal dimension. Histologically, it was composed of cells arranged in cords, most of which were two-cell-thick and separated by sinusoids. Focal fatty change and excessive glycogen storage were observed. The tumor cells were round or polygonal in shape, resembling the surrounding parenchymal cells. Mitosis was not found. No portal tract, central vein or ductule was found within the lesion. The tumor tissue showed a positive reaction for cytokeratin (CK) 18, but not for CK19, vimentin, estrogen and progesterone receptors. Monoclonality was demonstrated for the lesion, confirming the diagnosis of an LCA. Clonality analysis is helpful for its distinction from focal nodular hyperplasia.
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Affiliation(s)
- Li Gong
- Department of Pathology, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, Shaanxi Provice, China
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15
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Affiliation(s)
- Adrian Reuben
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
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16
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Santarelli L, Gabrielli M, Orefice R, Nista EC, Serricchio M, Nestola M, Rapaccini G, De Ninno M, Pola P, Gasbarrini G, Gasbarrini A. Association between Klinefelter syndrome and focal nodular hyperplasia. J Clin Gastroenterol 2003; 37:189-91. [PMID: 12869895 DOI: 10.1097/00004836-200308000-00020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Focal nodular hyperplasia is a benign lesion of the liver, predominantly affecting women. Its etiology is unknown. Elevated levels of estrogens have been invoked to play a role in the disease. Klinefelter syndrome is the most common sex chromosome disorder, characterized by 47, XXY karyotype, resulting in male hypogonadism and sex hormone imbalance. We present a case of a 25-year-old man affected by Klinefelter syndrome, admitted to our hospital for aspecific dyspeptic symptoms. During admission he underwent: blood test for the liver function and sexual hormonal status, ultrasonography, echo color power Doppler and computerized tomography scan of the liver, and liver biopsy. A hypergonadotropic hypogonadism was present. Imaging of the liver showed an hepatic lesion that liver biopsy confirmed to be a focal nodular hyperplasia. Although the association could be casual, the sex hormone imbalance present in Klinefelter syndrome may suggest a role in the development of this benign liver lesion.
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Affiliation(s)
- Luca Santarelli
- Internal Medicine Department, Catholic University of Sacred Heart, Rome, Italy
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17
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Lepreux S, Laurent C, Balabaud C, Bioulac-Sage P. FNH-like nodules: Possible precursor lesions in patients with focal nodular hyperplasia (FNH). COMPARATIVE HEPATOLOGY 2003; 2:7. [PMID: 12869206 PMCID: PMC166154 DOI: 10.1186/1476-5926-2-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2002] [Accepted: 06/26/2003] [Indexed: 12/31/2022]
Abstract
BACKGROUND: The typical lesion of focal nodular hyperplasia (FNH) is a benign tumor-like mass characterized by hepatocytic nodules separated by fibrous bands. The solitary central artery with high flow and the absent portal vein give the lesions their characteristic radiological appearance. The great majority of cases seen in daily practice conform to the above description. Additional small nodules (from 1-2 up to 15-20 mm in diameter) detected by imaging techniques or on macroscopic examination may be difficult to identify as representing FNH if they lack the key features of FNH as defined in larger lesions. The aim of this study was to characterize these small nodules, and to compare their characteristics with those of typical lesions of FNH present in the same specimens. RESULTS: Eight patients underwent hepatic resections for the removal of a mass lesion ("nodule") diagnosed as: FNH (1 patient); nodules of unknown nature (5 patients); or nodules thought to be adenoma or hepatocellular carcinoma (2 patients). Six nodules out of 9 discovered by imaging techniques met histopathological criteria for the diagnosis of typical FNH, at least in parts of the nodule; 2 nodules corresponded to a minor form of FNH ("subtle FNH") and one nodule to a steatotic area. Although FNH was thought to be found in a normal or nearly normal liver, this study revealed that, in addition, there were various types of small FNH-like nodules and vascular abnormalities in the liver with typical FNH nodule. The various types of small FNH-like nodules (n = 8, diameter 2 to 20 mm) consisted of the association to various degrees of numerous and/or enlarged arteries in portal tracts or in septa, with hyperplastic foci, slight ductular reaction, and regions of sinusoidal dilatation, accompanied by thin fibrous bands. Vascular abnormalities consisted of unpaired arteries, portal tracts with arteries larger than the associated bile duct, and regions of sinusoidal dilatation. CONCLUSIONS: Although these small nodules can be considered as insufficient type or abortive forms of FNH, or adenoma, they can be precursors of the large mass lesions in which FNH was recognized and defined.
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Affiliation(s)
- Sébastien Lepreux
- Service d'Anatomie Pathologique, Hôpital Pellegrin, Bordeaux, France
| | - Christophe Laurent
- Service de Chirurgie Digestive et de Transplantation Hépatique, Hôpital St André, CHU Bordeaux, France
| | - Charles Balabaud
- Service de Hépato-gastroentérologie, Hôpital St André, CHU Bordeaux, France
- GREF/INSERM E0362, Université Bordeaux 2, 146, rue Léo Saignat, 33076 Bordeaux Cedex, France
| | - Paulette Bioulac-Sage
- Service d'Anatomie Pathologique, Hôpital Pellegrin, Bordeaux, France
- GREF/INSERM E0362, Université Bordeaux 2, 146, rue Léo Saignat, 33076 Bordeaux Cedex, France
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Laurent C, Trillaud H, Lepreux S, Balabaud C, Bioulac-Sage P. Association of adenoma and focal nodular hyperplasia: experience of a single French academic center. COMPARATIVE HEPATOLOGY 2003; 2:6. [PMID: 12812524 PMCID: PMC161818 DOI: 10.1186/1476-5926-2-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2002] [Accepted: 04/23/2003] [Indexed: 12/15/2022]
Abstract
BACKGROUND: We report our experience of the simultaneous occurrence of adenoma and focal nodular hyperplasia (FNH). Liver cell adenoma together with FNH was found in five out of 30 cases of "multiple benign hepatocytic nodules" collected in our files of the Department of Pathology of the University Hospital of Bordeaux, during the last 12 years. All five cases were women on oral contraceptives. In all cases, the reason for surgery was the discovery, by imaging techniques, of an adenoma (4 cases) or of an unidentified benign tumor, possibly an adenoma. RESULTS: Four cases of FNH were discovered by imaging techniques, prior to surgery. Additional small nodules were diagnosed either during surgery or during the slicing of the specimen in 3 cases. Adenoma and the FNH cases identified by imaging techniques were confirmed as such by light microscopy. Some small nodules could not be categorized with certainty because they contained biliary structures without ductular reaction. In one case, the non-nodular liver was abnormal around the area in which there were multiple nodules: there was approximation of portal tracts with portal and hepatic venous thromboses, and portal tract remnants with arteries surrounded with a rim of fibrosis. In two cases, some large hepatic veins had thickened walls. CONCLUSIONS: The association of FNH and adenoma could be coincidental or secondary to shared causal mechanisms: a) systemic and local angiogenic abnormalities induced by oral contraceptives; b) tumor-induced growth factors; c) thrombosis and local arterio-venous shunting. A better recognition of the association of adenoma and FNH, particularly in the context of multiple nodules, could be useful in clinical practice.
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Affiliation(s)
- Christophe Laurent
- Fédération d'Hépato-gastro-entérologie, Hôpitaux Saint-André et Haut-Lévêque, France
- GREF INSERM E0362 – Université Bordeaux 2, 33076 Bordeaux Cedex, France
| | - Hervé Trillaud
- Fédération d'Hépato-gastro-entérologie, Hôpitaux Saint-André et Haut-Lévêque, France
| | - Sébastien Lepreux
- Service d'Anatomie Pathologique Hôpital Pellegrin, CHU Bordeaux, France
- GREF INSERM E0362 – Université Bordeaux 2, 33076 Bordeaux Cedex, France
| | - Charles Balabaud
- Fédération d'Hépato-gastro-entérologie, Hôpitaux Saint-André et Haut-Lévêque, France
- GREF INSERM E0362 – Université Bordeaux 2, 33076 Bordeaux Cedex, France
| | - Paulette Bioulac-Sage
- Service d'Anatomie Pathologique Hôpital Pellegrin, CHU Bordeaux, France
- GREF INSERM E0362 – Université Bordeaux 2, 33076 Bordeaux Cedex, France
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19
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Abstract
Various identified risk factors predispose to hepatocellular adenomas. We present the case of a young woman with liver adenoma in a context of polycystic ovary syndrome, associated with high levels of androgens and following a high dose hormonal therapy. In view of this complication, we recommend a close screening of patients with such hormonal imbalance, especially those who are treated with high doses of hormones, with repeated liver tests and ultrasonographies.
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Affiliation(s)
- Christian Toso
- Clinique et Policlinique de Chirurgie digestive, Département de chirurgie, Hôpitaux Universitaires Genève, Rue Michelidu-Crest, 24 CH-1211, Genève.
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20
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Abstract
A 38-year-old woman developed focal nodular hyperplasia of the liver after she had received a 4-month treatment with intraconazole 200 mg/d for a fungal infection of her fingernails. Because the patient underwent yearly liver ultrasound examinations because of the removal of a breast carcinoma, when the tumor was discovered incidentally, it was clear that it had developed within the past year after she had begun receiving intraconazole. Although various chemical agents and drugs have been considered as possible etiologic factors in the development of focal nodular hyperplasia of the liver, cases occurring after intraconazole therapy have not been reported before. Apart from the theoretical considerations with regard to the pathogenesis of nodular hyperplasia of the liver, this case could gain practical importance, as it shows a new adverse effect of a drug that has been used in more than 34 million patients over the past 10 years. Furthermore, this case should draw attention to the possibility of drug-induced benign hepatic tumors, as they may mimic malignant and metastatic disorders, which might be especially alarming in patients undergoing routine examinations after removal of malignant tumors, such as our patient.
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Affiliation(s)
- R Wolf
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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22
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Abstract
We report two cases of hepatocyte neoplasia with extensive deposition of Dubin-Johnson-like pigment in men without Dubin-Johnson syndrome. This pigment has previously been described in hepatocellular carcinoma but not in liver cell adenoma. The tumors of both patients showed some atypical cytologic features, but no frank histologic evidence of malignancy. Long-term follow up for several years showed no evidence of recurrence after limited surgical excision. We conclude that tumors with this structure may be cured by limited surgical excision and should be considered as pigmented liver cell adenomas.
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Affiliation(s)
- N Hasan
- Institute of Liver Studies, Guy's King's and St. Thomas' School of Medicine, London, UK
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23
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Prasad VK, Aronson DC, Gerald WL, Meyers PA, La Quaglia MP. Hepatic focal nodular hyperplasia in infant antenatally exposed to steroids. Lancet 1995; 346:371. [PMID: 7623541 DOI: 10.1016/s0140-6736(95)92249-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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24
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Takamura M, Mugishima H, Oowada M, Harada K, Uchida T. Type La glycogen storage disease with focal nodular hyperplasia in siblings. ACTA PAEDIATRICA JAPONICA : OVERSEAS EDITION 1995; 37:510-3. [PMID: 7572155 DOI: 10.1111/j.1442-200x.1995.tb03365.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Glycogen storage disease type I (GSD-I) is an inherited disorder that is due to a glucose-6-phosphatase (G6Pase) deficiency. There have been recent reports of hepatocellular tumors in adults with this disease. Hepatic adenoma is the most common tumor described but others, including hepatocellular carcinomas, hepatoblastomas, and focal nodular hyperplasia (FNH) have been reported. FNH of the liver is a rare benign lesion that has been reported in eight patients with GSD-I. Three of these eight patients, in addition to the patient in our study, had been treated with portacaval shunts. When these patients were compared with patients who had not received such treatment, it appeared that the portacaval shunts may have induced the development of FNH and may have been associated with earlier complications. FNH is a benign tumor that may coexist with adjacent fibrolamillar carcinomas and/or adenomas and requires careful follow-up.
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Affiliation(s)
- M Takamura
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
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26
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Abstract
We studied the effect of antiandrogen treatment on the Solt-Farber model of hepatocarcinogenesis in male Sprague-Dawley rats. The size and number of the liver tumors were reduced by various antiandrogen treatments (orchiectomy, an LH-RH analog, and chlormadinone acetate). In addition, the proportion of poorly differentiated carcinomas was decreased by the antiandrogen treatment, while that of well-differentiated trabecular or glandular carcinomas was increased. The bromodeoxyuridine labeling index of the tumor cells was significantly decreased after the antiandrogen treatment. The expression of rat androgen receptor mRNA in carcinoma tissue was increased when compared to control liver tissue, and was decreased after the antiandrogen treatment. Orchiectomy had the greatest inhibitory effect on carcinoma, although the effect of chemical orchiectomy using an LH-RH analog was almost similar to that of orchiectomy. These results suggest that the clinical application of antiandrogen therapy for human hepatocellular carcinoma might be possible in the future.
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MESH Headings
- Androgen Antagonists/pharmacology
- Animals
- Blotting, Northern
- Cell Division/drug effects
- Cell Nucleus/chemistry
- Cell Nucleus/ultrastructure
- Cell Transformation, Neoplastic/drug effects
- Cell Transformation, Neoplastic/pathology
- Chlormadinone Acetate/pharmacology
- Disease Models, Animal
- Gonadotropin-Releasing Hormone/pharmacology
- Liver/chemistry
- Liver/pathology
- Liver/ultrastructure
- Liver Neoplasms, Experimental/pathology
- Male
- Orchiectomy
- RNA, Messenger/analysis
- RNA, Messenger/genetics
- Rats
- Rats, Sprague-Dawley
- Receptors, Androgen/analysis
- Receptors, Androgen/genetics
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Affiliation(s)
- B Matsuura
- Third Department of Internal Medicine, Ehime University School of Medicine, Japan
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29
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Nakagama H, Gunji T, Ohnishi S, Kaneko T, Ishikawa T, Makino R, Hayashi K, Shiga J, Takaku F, Imawari M. Expression of androgen receptor mRNA in human hepatocellular carcinomas and hepatoma cell lines. Hepatology 1991; 14:99-102. [PMID: 1648543 DOI: 10.1002/hep.1840140116] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The expression of androgen receptor messenger RNA in hepatocellular carcinomas and hepatoma cell lines was studied using Northern-blot analysis and the complementary DNA-polymerase chain reaction method. Androgen receptor messenger RNAs were detected (although in low levels) in both hepatocellular carcinoma tissues and noncancerous tissues of the liver in all eight cases we studied, except for the tumor sample of one case. None of the hepatoma cell lines studied, however, expressed detectable levels of androgen receptor messenger RNA except for the SK-HEP-1 hepatoma cell line.
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Affiliation(s)
- H Nakagama
- Third Department of Internal Medicine, Faculty of Medicine, University of Tokyo, Japan
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