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An SL, Wang LM, Rong WQ, Wu F, Sun W, Yu WB, Feng L, Liu FQ, Tian F, Wu JX. Hepatocellular adenoma with malignant transformation in male patients with non-cirrhotic livers. CHINESE JOURNAL OF CANCER 2015; 34:217-24. [PMID: 26058379 PMCID: PMC4593344 DOI: 10.1186/s40880-015-0014-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/22/2014] [Indexed: 02/07/2023]
Abstract
Introduction Hepatocellular adenomas (HCAs), with a risk of malignant transformation into hepatocellular carcinoma (HCC), classically develop in young women who are taking oral contraceptives. It is now clear that HCAs may also occur in men. However, it is rarely reported that HCAs with malignant transformation occur in male patients with non-cirrhotic livers. This study aimed to characterize the malignancy of HCAs occurring in male patients. Methods All patients with HCAs with malignant transformation who underwent hepatectomy at the Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between January 1, 1999 and December 31, 2011 were enrolled in the study. The clinical characteristics as well as radiologic and pathologic data were reviewed. Results HCAs with malignant transformation were observed in 5 male patients with non-cirrhotic livers, but not in female patients. The alpha-fetoprotein (AFP) levels were higher in patients with HCAs with malignant transformation than in patients with HCAs without malignant transformation. The diameters of the tumors with malignant transformation were larger than 5 cm in 3 cases and smaller than 5 cm in 2 cases. The 5 patients were all alive without recurrence by the end of the study period. The disease-free survival times of the 5 patients were 26, 48, 69, 69, and 92 months. Conclusion Our results indicate that resection would be advised even if the presumptive diagnosis is adenoma smaller than 5 cm in diameter, especially in male patients.
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Affiliation(s)
- Song-Lin An
- Department of Abdominal Surgery, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuannanli Road, , Chaoyang District, Beijing, 100021, P. R. China.
| | - Li-Ming Wang
- Department of Abdominal Surgery, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuannanli Road, , Chaoyang District, Beijing, 100021, P. R. China.
| | - Wei-Qi Rong
- Department of Abdominal Surgery, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuannanli Road, , Chaoyang District, Beijing, 100021, P. R. China.
| | - Fan Wu
- Department of Abdominal Surgery, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuannanli Road, , Chaoyang District, Beijing, 100021, P. R. China.
| | - Wei Sun
- Department of Pathology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, P. R. China.
| | - Wei-Bo Yu
- Department of Abdominal Surgery, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuannanli Road, , Chaoyang District, Beijing, 100021, P. R. China.
| | - Li Feng
- Department of Abdominal Surgery, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuannanli Road, , Chaoyang District, Beijing, 100021, P. R. China.
| | - Fa-Qiang Liu
- Department of Abdominal Surgery, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuannanli Road, , Chaoyang District, Beijing, 100021, P. R. China.
| | - Fei Tian
- Department of Abdominal Surgery, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuannanli Road, , Chaoyang District, Beijing, 100021, P. R. China.
| | - Jian-Xiong Wu
- Department of Abdominal Surgery, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuannanli Road, , Chaoyang District, Beijing, 100021, P. R. China.
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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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Bioulac-Sage P, Laumonier H, Laurent C, Zucman-Rossi J, Balabaud C. Hepatocellular adenoma: what is new in 2008. Hepatol Int 2008; 2:316-21. [PMID: 19669260 PMCID: PMC2716879 DOI: 10.1007/s12072-008-9075-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 03/12/2008] [Indexed: 02/06/2023]
Abstract
Patients (85%) with hepatocellular adenoma (HCA) are women taking oral contraceptives. They can be divided into four subgroups according to their genotype/phenotype features. (1) Hepatocyte nuclear factor 1α (HNF1α) biallelic somatic mutations are observed in 35% of the HCA cases. It occurs in almost all cases in women. HNF1α-mutated HCA are most of the time, highly steatotic, with a lack of expression of liver fatty acid binding protein (LFABP) in immunohistochemistry analyses. Adenomatosis is frequently detected in this context. An HNF1α germline mutation is observed in less than 5% of HCA cases and can be associated with MODY 3 diabetes. (2) An activating β-catenin mutation was found in 10% of HCA. These β-catenin activated HCAs are observed in men and women, and specific risk factors, such as male hormone administration or glycogenosis, are associated with their development. Immunohistochemistry studies show that these HCAs overexpress β-catenin (nuclear and cytoplasmic) and glutamine synthetase. This group of tumours has a higher risk of malignant transformation into hepatocellular carcinoma. (3) Inflammatory HCAs are observed in 40% of the cases, and they are most frequent in women but are also found in men. Lesions are characterised by inflammatory infiltrates, dystrophic arteries, sinusoidal dilatation and ductular reaction. They express serum amyloid A and C-reactive protein. In this group, GGT is frequently elevated, with a biological inflammatory syndrome present. Also, there are more overweight patients in this group. An additional 10% of inflammatory HCAs express β-catenin, and are also at risk of malignant transformation. (4) Currently, less than 10% of HCAs are unclassified. It is hoped that in the near future it will be possible with clinical, biological and imaging data to predict in which of the 2 major groups (HNF1α-mutated HCA and inflammatory HCA) the patient belongs and to propose better guidelines in terms of surveillance and treatment.
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Affiliation(s)
- Paulette Bioulac-Sage
- Department of Pathology, Hôpital Pellegrin CHU Bordeaux, Université Bordeaux 2, Inserm 889, Bordeaux Cedex, France
| | - Hervé Laumonier
- Department of Radiology, Hôpital St André CHU Bordeaux, Bordeaux Cedex, France
| | - Christophe Laurent
- Department of Surgery, Hôpital St André CHU Bordeaux, Bordeaux Cedex, France
| | | | - Charles Balabaud
- Department of Hepatology, Hôpital St André CHU Bordeaux, Université Bordeaux 2, Inserm 889, Bordeaux Cedex, France
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Rebouissou S, Bioulac-Sage P, Zucman-Rossi J. Molecular pathogenesis of focal nodular hyperplasia and hepatocellular adenoma. J Hepatol 2008; 48:163-70. [PMID: 17997499 DOI: 10.1016/j.jhep.2007.10.003] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Revised: 10/14/2007] [Accepted: 10/16/2007] [Indexed: 12/12/2022]
Abstract
Focal nodular hyperplasia (FNH) and hepatocellular adenomas (HCAs) are benign tumors that occur in otherwise normal liver parenchyma. FNH is considered to be the result of a hyperplastic response to increased blood flow secondary to vascular malformations. Most FNH are polyclonal and to date, the molecular pathway and mechanisms that are altered in FNH have yet to be elucidated. In contrast, HCAs are consistently monoclonal tumors, which have been divided up into three subtypes of tumors depending on the molecular alteration detected in the tumors: HNF1alpha inactivation, beta-catenin activation and/or an acute inflammatory response in the tumor. These molecular features are closely related to clinical and pathological characteristics, and one of the most critical correlations is the higher risk of malignant transformation for beta-catenin activated HCA cases. Moreover, various risk factors, such as oral contraception and obesity, are associated with HCA occurrence and may collaborate with constitutional genetic predisposition related to HNF1alpha or CYP1B1 germline mutations. Altogether, the recent identification of different molecular pathways that contribute to tumor development has significantly increased our knowledge of benign hepatocellular tumorigenesis. These findings may modify our clinical practice, particularly in the diagnosis and follow-up of HCA patients.
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Affiliation(s)
- Sandra Rebouissou
- Inserm, U674, Génomique fonctionnelle des tumeurs solides, Génétique des tumeurs hépatiques, Paris, France
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