1
|
Frenette C, Mendiratta-Lala M, Salgia R, Wong RJ, Sauer BG, Pillai A. ACG Clinical Guideline: Focal Liver Lesions. Am J Gastroenterol 2024; 119:1235-1271. [PMID: 38958301 DOI: 10.14309/ajg.0000000000002857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 04/25/2024] [Indexed: 07/04/2024]
Abstract
Focal liver lesions (FLLs) have become an increasingly common finding on abdominal imaging, especially asymptomatic and incidental liver lesions. Gastroenterologists and hepatologists often see these patients in consultation and make recommendations for management of multiple types of liver lesions, including hepatocellular adenoma, focal nodular hyperplasia, hemangioma, and hepatic cystic lesions including polycystic liver disease. Malignancy is important to consider in the differential diagnosis of FLLs, and healthcare providers must be familiar with the diagnosis and management of FLLs. This American College of Gastroenterology practice guideline uses the best evidence available to make diagnosis and management recommendations for the most common FLLs.
Collapse
Affiliation(s)
| | | | - Reena Salgia
- Department of Gastroenterology/Hepatology, Henry Ford Health, Detroit, Michigan, USA
| | - Robert J Wong
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System and Stanford University School of Medicine, Palo Alto, California, USA
| | - Bryan G Sauer
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA
| | - Anjana Pillai
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Chicago Medical Center, University of Chicago, Chicago, Illinois, USA
| |
Collapse
|
2
|
Wilken S, Thevathasan T, Kamali C, Guillot A, Ihlow J, Fehrenbach U, Danyel M, Pratschke J, Tacke F, Krenzien F. Patient with a novel syndrome with multiple benign hepatic lesions and extrahepatic neoplasms. Clin J Gastroenterol 2024; 17:300-306. [PMID: 38133737 PMCID: PMC10960739 DOI: 10.1007/s12328-023-01899-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023]
Abstract
Simultaneous occurrence of benign hepatic lesions of different types is a sporadic phenomenon. To the best of our knowledge, we report the first clinical case of a syndrome with simultaneous manifestations of three different entities of benign liver tumors (hepatocellular adenoma, focal nodular hyperplasia and hemangioma) with a novel mutation detected in the liver adenoma and in the presence of a number of further extrahepatic organ neoplasms. Furthermore, we describe for the first time the presence of liver epithelial cells of hepatocytic phenotype expressing cytokeratin 7 (CK7) at the border of the adenoma. These findings may be important for explaining pathogenesis of benign as well as malignant tumors based on genetic and histopathological features.
Collapse
Affiliation(s)
- Silvana Wilken
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Tharusan Thevathasan
- Department of Cardiology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Charitéplatz 1, 10117, Berlin, Germany
| | - Can Kamali
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Adrien Guillot
- Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Campus Charité Mitte, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Jana Ihlow
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Uli Fehrenbach
- Clinic for Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Magdalena Danyel
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Charitéplatz 1, 10117, Berlin, Germany
- Institute of Medical Genetics and Human Genetics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, 13353, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Campus Charité Mitte, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Felix Krenzien
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Charitéplatz 1, 10117, Berlin, Germany.
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité- Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| |
Collapse
|
3
|
Bucurica S, Lupanciuc M, Ionita-Radu F, Stefan I, Munteanu AE, Anghel D, Jinga M, Gaman EL. Estrobolome and Hepatocellular Adenomas-Connecting the Dots of the Gut Microbial β-Glucuronidase Pathway as a Metabolic Link. Int J Mol Sci 2023; 24:16034. [PMID: 38003224 PMCID: PMC10671049 DOI: 10.3390/ijms242216034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
Hepatocellular adenomas are benign endothelial tumors of the liver, mostly associated with female individual users of estrogen-containing medications. However, the precise factors underlying the selective development of hepatic adenomas in certain females remain elusive. Additionally, the conventional profile of individuals prone to hepatic adenoma is changing. Notably, male patients exhibit a higher risk of malignant progression of hepatocellular adenomas, and there are instances where hepatic adenomas have no identifiable cause. In this paper, we theorize the role of the human gastrointestinal microbiota, specifically, of bacterial species producing β-glucuronidase enzymes, in the development of hepatic adenomas through the estrogen recycling pathway. Furthermore, we aim to address some of the existing gaps in our knowledge of pathophysiological pathways which are not yet subject to research or need to be studied further. As microbial β-glucuronidases proteins recycle estrogen and facilitate the conversion of inactive estrogen into its active form, this process results in elevated levels of unbound plasmatic estrogen, leading to extended exposure to estrogen. We suggest that an imbalance in the estrobolome could contribute to sex hormone disease evolution and, consequently, to the advancement of hepatocellular adenomas, which are estrogen related.
Collapse
Affiliation(s)
- Sandica Bucurica
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania;
- Department of Gastroenterology, “Dr. Carol Davila” Central Military Emergency University Hospital, 010242 Bucharest, Romania;
| | - Mihaela Lupanciuc
- Department of Gastroenterology, “Dr. Carol Davila” Central Military Emergency University Hospital, 010242 Bucharest, Romania;
| | - Florentina Ionita-Radu
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania;
- Department of Gastroenterology, “Dr. Carol Davila” Central Military Emergency University Hospital, 010242 Bucharest, Romania;
| | - Ion Stefan
- Department of Infectious Diseases, “Dr. Carol Davila” Central Military Emergency University Hospital, 010242 Bucharest, Romania;
- Department of Medico-Surgical and Prophylactic Disciplines, Titu Maiorescu University, 031593 Bucharest, Romania; (A.E.M.); (D.A.)
| | - Alice Elena Munteanu
- Department of Medico-Surgical and Prophylactic Disciplines, Titu Maiorescu University, 031593 Bucharest, Romania; (A.E.M.); (D.A.)
- Department of Cardiology, “Dr. Carol Davila” Central Military Emergency University Hospital, 010242 Bucharest, Romania
| | - Daniela Anghel
- Department of Medico-Surgical and Prophylactic Disciplines, Titu Maiorescu University, 031593 Bucharest, Romania; (A.E.M.); (D.A.)
- Department of Internal Medicine, “Dr. Carol Davila” Central Military Emergency University Hospital, 010242 Bucharest, Romania
| | - Mariana Jinga
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania;
- Department of Gastroenterology, “Dr. Carol Davila” Central Military Emergency University Hospital, 010242 Bucharest, Romania;
| | - Elena Laura Gaman
- Department of Biochemistry, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania;
| |
Collapse
|
4
|
Yang KL, Rogers D. Imaging of Hepatocellular Adenomas: From Molecular Biology to MRI. CURRENT RADIOLOGY REPORTS 2022. [DOI: 10.1007/s40134-022-00400-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
5
|
Katabathina VS, Khanna L, Surabhi VR, Minervini M, Shanbhogue K, Dasyam AK, Prasad SR. Morphomolecular Classification Update on Hepatocellular Adenoma, Hepatocellular Carcinoma, and Intrahepatic Cholangiocarcinoma. Radiographics 2022; 42:1338-1357. [PMID: 35776676 DOI: 10.1148/rg.210206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hepatocellular adenomas (HCAs), hepatocellular carcinomas (HCCs), and intrahepatic cholangiocarcinomas (iCCAs) are a highly heterogeneous group of liver tumors with diverse pathomolecular features and prognoses. High-throughput gene sequencing techniques have allowed discovery of distinct genetic and molecular underpinnings of these tumors and identified distinct subtypes that demonstrate varied clinicobiologic behaviors, imaging findings, and complications. The combination of histopathologic findings and molecular profiling form the basis for the morphomolecular classification of liver tumors. Distinct HCA subtypes with characteristic imaging findings and complications include HNF1A-inactivated, inflammatory, β-catenin-activated, β-catenin-activated inflammatory, and sonic hedgehog HCAs. HCCs can be grouped into proliferative and nonproliferative subtypes. Proliferative HCCs include macrotrabecular-massive, TP53-mutated, scirrhous, clear cell, fibrolamellar, and sarcomatoid HCCs and combined HCC-cholangiocarcinoma. Steatohepatitic and β-catenin-mutated HCCs constitute the nonproliferative subtypes. iCCAs are classified as small-duct and large-duct types on the basis of the level of bile duct involvement, with significant differences in pathogenesis, molecular signatures, imaging findings, and biologic behaviors. Cross-sectional imaging modalities, including multiphase CT and multiparametric MRI, play an essential role in diagnosis, staging, treatment response assessment, and surveillance. Select imaging phenotypes can be correlated with genetic abnormalities, and identification of surrogate imaging markers may help avoid genetic testing. Improved understanding of morphomolecular features of liver tumors has opened new areas of research in the targeted therapeutics and management guidelines. The purpose of this article is to review imaging findings of select morphomolecular subtypes of HCAs, HCCs, and iCCAs and discuss therapeutic and prognostic implications. Online supplemental material is available for this article. ©RSNA, 2022.
Collapse
Affiliation(s)
- Venkata S Katabathina
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., L.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S., S.R.P.); Departments of Pathology (M.M.) and Radiology (A.K.D.), University of Pittsburgh Medical Center, Pittsburgh, Pa; and Department of Radiology, NYU Medical Center, New York, NY (K.S.)
| | - Lokesh Khanna
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., L.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S., S.R.P.); Departments of Pathology (M.M.) and Radiology (A.K.D.), University of Pittsburgh Medical Center, Pittsburgh, Pa; and Department of Radiology, NYU Medical Center, New York, NY (K.S.)
| | - Venkateswar R Surabhi
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., L.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S., S.R.P.); Departments of Pathology (M.M.) and Radiology (A.K.D.), University of Pittsburgh Medical Center, Pittsburgh, Pa; and Department of Radiology, NYU Medical Center, New York, NY (K.S.)
| | - Marta Minervini
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., L.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S., S.R.P.); Departments of Pathology (M.M.) and Radiology (A.K.D.), University of Pittsburgh Medical Center, Pittsburgh, Pa; and Department of Radiology, NYU Medical Center, New York, NY (K.S.)
| | - Krishna Shanbhogue
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., L.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S., S.R.P.); Departments of Pathology (M.M.) and Radiology (A.K.D.), University of Pittsburgh Medical Center, Pittsburgh, Pa; and Department of Radiology, NYU Medical Center, New York, NY (K.S.)
| | - Anil K Dasyam
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., L.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S., S.R.P.); Departments of Pathology (M.M.) and Radiology (A.K.D.), University of Pittsburgh Medical Center, Pittsburgh, Pa; and Department of Radiology, NYU Medical Center, New York, NY (K.S.)
| | - Srinivasa R Prasad
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., L.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S., S.R.P.); Departments of Pathology (M.M.) and Radiology (A.K.D.), University of Pittsburgh Medical Center, Pittsburgh, Pa; and Department of Radiology, NYU Medical Center, New York, NY (K.S.)
| |
Collapse
|
6
|
LeGout JD, Bolan CW, Bowman AW, Caserta MP, Chen FK, Cox KL, Sanyal R, Toskich BB, Lewis JT, Alexander LF. Focal Nodular Hyperplasia and Focal Nodular Hyperplasia-like Lesions. Radiographics 2022; 42:1043-1061. [PMID: 35687520 DOI: 10.1148/rg.210156] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Focal nodular hyperplasia (FNH) is a benign lesion occurring in a background of normal liver. FNH is seen most commonly in young women and can often be accurately diagnosed at imaging, including CT, MRI, or contrast-enhanced US. In the normal liver, FNH frequently must be differentiated from hepatocellular adenoma, which although benign, is managed differently because of the risks of hemorrhage and malignant transformation. When lesions that are histologically identical to FNH occur in a background of abnormal liver, they are termed FNH-like lesions. These lesions can be a source of diagnostic confusion and must be differentiated from malignancies. Radiologists' familiarity with the imaging appearance of FNH-like lesions and knowledge of the conditions that predispose a patient to their formation are critical to minimizing the risks of unnecessary intervention for these lesions, which are rarely symptomatic and carry no risk for malignant transformation. FNH is thought to form secondary to an underlying vascular disturbance, a theory supported by the predilection for formation of FNH-like lesions in patients with a variety of hepatic vascular abnormalities. These include abnormalities of hepatic outflow such as Budd-Chiari syndrome, abnormalities of hepatic inflow such as congenital absence of the portal vein, and hepatic microvascular disturbances, such as those that occur after exposure to certain chemotherapeutic agents. Familiarity with the imaging appearances of these varied conditions and knowledge of their association with formation of FNH-like lesions allow radiologists to identify with confidence these benign lesions that require no intervention. Online supplemental material is available for this article. ©RSNA, 2022.
Collapse
Affiliation(s)
- Jordan D LeGout
- From the Department of Radiology (J.D.L., C.W.B., A.W.B., M.P.C., F.K.C., K.L.C., R.S., B.B.T., L.F.A.) and Department of Laboratory Medicine and Pathology (J.T.L.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Candice W Bolan
- From the Department of Radiology (J.D.L., C.W.B., A.W.B., M.P.C., F.K.C., K.L.C., R.S., B.B.T., L.F.A.) and Department of Laboratory Medicine and Pathology (J.T.L.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Andrew W Bowman
- From the Department of Radiology (J.D.L., C.W.B., A.W.B., M.P.C., F.K.C., K.L.C., R.S., B.B.T., L.F.A.) and Department of Laboratory Medicine and Pathology (J.T.L.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Melanie P Caserta
- From the Department of Radiology (J.D.L., C.W.B., A.W.B., M.P.C., F.K.C., K.L.C., R.S., B.B.T., L.F.A.) and Department of Laboratory Medicine and Pathology (J.T.L.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Frank K Chen
- From the Department of Radiology (J.D.L., C.W.B., A.W.B., M.P.C., F.K.C., K.L.C., R.S., B.B.T., L.F.A.) and Department of Laboratory Medicine and Pathology (J.T.L.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Kelly L Cox
- From the Department of Radiology (J.D.L., C.W.B., A.W.B., M.P.C., F.K.C., K.L.C., R.S., B.B.T., L.F.A.) and Department of Laboratory Medicine and Pathology (J.T.L.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Rupan Sanyal
- From the Department of Radiology (J.D.L., C.W.B., A.W.B., M.P.C., F.K.C., K.L.C., R.S., B.B.T., L.F.A.) and Department of Laboratory Medicine and Pathology (J.T.L.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Beau B Toskich
- From the Department of Radiology (J.D.L., C.W.B., A.W.B., M.P.C., F.K.C., K.L.C., R.S., B.B.T., L.F.A.) and Department of Laboratory Medicine and Pathology (J.T.L.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Jason T Lewis
- From the Department of Radiology (J.D.L., C.W.B., A.W.B., M.P.C., F.K.C., K.L.C., R.S., B.B.T., L.F.A.) and Department of Laboratory Medicine and Pathology (J.T.L.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Lauren F Alexander
- From the Department of Radiology (J.D.L., C.W.B., A.W.B., M.P.C., F.K.C., K.L.C., R.S., B.B.T., L.F.A.) and Department of Laboratory Medicine and Pathology (J.T.L.), Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224
| |
Collapse
|
7
|
Wang X, Zhang X. Hepatocellular adenoma: Where are we now? World J Gastroenterol 2022; 28:1384-1393. [PMID: 35582672 PMCID: PMC9048476 DOI: 10.3748/wjg.v28.i14.1384] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/09/2022] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular adenoma (HCA) is a benign hepatocellular neoplasm, commonly occurs in young women with a history of oral contraceptive use. Complications including hemorrhage and malignant transformation necessitate the need for a thorough understanding of the underlying molecular signatures in this entity. Recent molecular studies have significantly expanded our knowledge of HCAs. The well-developed phenotype-genotype classification system improves clinical management through identifying “high risk” subtype of HCAs. In this article, we attempt to provide updated information on clinical, pathologic and molecular features of each subtype of HCAs.
Collapse
Affiliation(s)
- Xi Wang
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06520, United States
| | - Xuchen Zhang
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06520, United States
| |
Collapse
|
8
|
Liu Y, Liu YZ, Sun L, Zen Y, Inomoto C, Yeh MM. Subtyping of hepatocellular adenoma: a machine learning-based approach. Virchows Arch 2022; 481:49-61. [PMID: 35389097 DOI: 10.1007/s00428-022-03311-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/08/2022] [Accepted: 03/13/2022] [Indexed: 11/26/2022]
Abstract
Subtyping of hepatocellular adenoma (HCA) is an important task in practice as different subtypes may have different clinical outcomes and management algorithms. Definitive subtyping is currently dependent on immunohistochemical and molecular testing. The association between some morphologic/clinical features and HCA subtypes has been reported; however, the predictive performance of these features has been controversial. In this study, we attempted machine learning based methods to select an efficient and parsimonious set of morphologic/clinical features for differentiating a HCA subtype from the others, and then assessed the performance of the selected features in identifying the correct subtypes. We first examined 50 liver HCA resection specimens collected at the University of Washington and Kobe University/Kings College London, including HNF1α-mutated HCA (H-HCA) (n = 16), inflammatory HCA (I-HCA) (n = 20), beta-catenin activated HCA (β-HCA) (n = 8), and unclassified HCA (U-HCA) (n = 6). Twenty-six morphologic/clinical features were assessed. We used LASSO (least absolute shrinkage and selection operator) to select key features that could differentiate a subtype from the others. We further performed SVM (support vector machine) analysis to assess the performance (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy) of the selected features in HCA subtyping in an independent cohort of liver resection samples (n = 20) collected at the University of Wisconsin-Madison. With some overlap, different combinations of morphologic/clinical features were selected for each subtype. Based on SVM analysis, the selected features classified HCA into correct subtypes with an overall accuracy of at least 80%. Our findings are useful for initial diagnosis and subtyping of HCA, especially in clinical settings without access to immunohistochemical and molecular assays.
Collapse
Affiliation(s)
- Yongjun Liu
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Yao-Zhong Liu
- Department of Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Lifu Sun
- Department of Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Yoh Zen
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
- Institute of Liver Studies, King's College Hospital & King's College London, London, UK
| | - Chie Inomoto
- Department of Pathology, Tokai University, Isehara, Japan
| | - Matthew M Yeh
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, 1959 NE Pacific Street, NE140D, Seattle, WA, 98195-6100, USA.
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
| |
Collapse
|
9
|
Aziz H, Brown ZJ, Eskander MF, Aquina CT, Baghdadi A, Kamel IR, Pawlik TM. A Scoping Review of the Classification, Diagnosis, and Management of Hepatic Adenomas. J Gastrointest Surg 2022; 26:965-978. [PMID: 35083725 DOI: 10.1007/s11605-022-05246-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/05/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hepatic adenomas (HA), or hepatocellular adenomas, are benign, solid liver lesions that develop in otherwise normal livers, often in the setting of increased estrogen levels. While considered a benign tumor, there is a risk for substantial complications such as hemorrhage and malignant transformation. We review the diagnosis, classification, and potential therapeutic management options for patients with HA. METHODS A scoping narrative review was conducted based on recent literature regarding classification, diagnosis, and management of HA. RESULTS While HAs are typically considered benign, complications such as hemorrhage and malignant transformation may occur in approximately 25% and 5% of patients, respectively. Recent advances in imaging and molecular profiling have allowed for the classification of HAs into subtypes allowing for patient risk stratification that helps guide management. Surgical resection should be considered in asymptomatic patients who are male, have an adenoma ≥5 cm in diameter, or have the β-catenin-activated subtype due to an increased risk of hemorrhage and/or malignant transformation. CONCLUSION Molecular profiling has aided in the stratification of patients relative to the risk of complications to predict better the potential behavior of HAs.
Collapse
Affiliation(s)
- Hassan Aziz
- Department of Surgery, Tufts University School of Medicine, Boston, MA, USA
| | - Zachary J Brown
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Mariam F Eskander
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Christopher T Aquina
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | | | - Ihab R Kamel
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA.
| |
Collapse
|
10
|
Ercan C, Coto-Llerena M, Gallon J, Fourie L, Marinucci M, Hess GF, Vosbeck J, Taha-Mehlitz S, Boldanova T, Meier MA, Tzankov A, Matter MS, Hoffmann MHK, Di Tommaso L, von Flüe M, Ng CKY, Heim MH, Soysal SD, Terracciano LM, Kollmar O, Piscuoglio S. Genomic analysis of focal nodular hyperplasia with associated hepatocellular carcinoma unveils its malignant potential: a case report. COMMUNICATIONS MEDICINE 2022; 2:11. [PMID: 35603298 PMCID: PMC9053256 DOI: 10.1038/s43856-022-00074-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 01/21/2022] [Indexed: 01/13/2023] Open
Abstract
Abstract
Background
Focal nodular hyperplasia (FNH) is typically considered a benign tumor of the liver without malignant potential. The co-occurrence of FNH and hepatocellular carcinoma (HCC) has been reported in rare cases. In this study we sought to investigate the clonal relationship between these lesions in a patient with FNH-HCC co-occurrence.
Methods
A 74-year-old female patient underwent liver tumor resection. The resected nodule was subjected to histologic analyses using hematoxylin and eosin stain and immunohistochemistry. DNA extracted from microdissected FNH and HCC regions was subjected to whole exome sequencing. Clonality analysis were performed using PyClone.
Results
Histologic analysis reveals that the nodule consists of an FNH and two adjoining HCC components with distinct histopathological features. Immunophenotypic characterization and genomic analyses suggest that the FNH is clonally related to the HCC components, and is composed of multiple clones at diagnosis, that are likely to have progressed to HCC through clonal selection and/or the acquisition of additional genetic events.
Conclusion
To the best of our knowledge, our work is the first study showing a clonal relationship between FNH and HCC. We show that FNH may possess the capability to undergo malignant transformation and to progress to HCC in very rare cases.
Collapse
|
11
|
Bioulac-Sage P, Gouw ASH, Balabaud C, Sempoux C. Hepatocellular Adenoma: What We Know, What We Do Not Know, and Why It Matters. Histopathology 2021; 80:878-897. [PMID: 34856012 DOI: 10.1111/his.14605] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/21/2021] [Accepted: 11/25/2021] [Indexed: 11/27/2022]
Abstract
In the last 2 decades there has been significant progress in research and diagnosis of hepatocellular adenoma (HCA), resulting in the establishment of a molecular and immunohistological HCA classification. This review aims to fine-tune the current expertise in order to enhance the histopathological diagnostic possibilities, by refining issues that are already known, addressing diagnostic difficulties and identifying still unknown aspects of HCA. We will discuss novel methods to identify HCA subtypes, in particular the sonic hedgehog HCAs and the interpretation of glutamine synthetase patterns for the recognition of beta-catenin mutated HCAs. The major complications of HCAs, bleeding and malignant transformation, will be considered, including the dilemmas of atypical and borderline lesions. Paragraphs on HCAs in different clinical and geographical settings, e.g. pregnancy, cirrhosis and non-western countries are included. The natural history of the different HCA subtypes in relation with age, sex and risk factors is a feature still insufficiently investigated. This is also true for the risks of clinical bleeding and malignant transformation in association with HCA subtypes. As HCA is a relatively rare tumor, a multicenter and multidisciplinary approach across geographical boundaries will be the appropriate method to establish prospective programs to identify, classify and manage HCAs, focusing on several aspects, e.g. etiology, underlying liver disease, complications, regression and growth. Updating what we know, identifying and addressing features that we do not know matters to warrant optimal patient management.
Collapse
Affiliation(s)
| | - Annette S H Gouw
- Departement of Pathology and Medical Biology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Christine Sempoux
- Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
12
|
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.
Collapse
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
| | | |
Collapse
|
13
|
Borgia M, Dal Bo M, Toffoli G. Role of Virus-Related Chronic Inflammation and Mechanisms of Cancer Immune-Suppression in Pathogenesis and Progression of Hepatocellular Carcinoma. Cancers (Basel) 2021; 13:cancers13174387. [PMID: 34503196 PMCID: PMC8431318 DOI: 10.3390/cancers13174387] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Hepatocellular carcinoma pathogenesis is dependent on a chronic inflammation caused by several factors, including hepatotropic viruses, such as HCV and HBV. This chronic inflammation is established in the context of the immunotolerogenic environment peculiar of the liver, in which the immune system can be stimulated by HCV and HBV viral antigens. This complex interaction can be influenced by direct-acting antiviral drug treatments, capable of (almost totally) rapidly eradicating HCV infection. The influence of anti-viral treatments on HCC pathogenesis and progression remains to be fully clarified. Abstract Hepatocellular carcinoma (HCC) can be classified as a prototypical inflammation-driven cancer that generally arises from a background of liver cirrhosis, but that in the presence of nonalcoholic steatohepatitis (NASH), could develop in the absence of fibrosis or cirrhosis. Tumor-promoting inflammation characterizes HCC pathogenesis, with an epidemiology of the chronic liver disease frequently encompassing hepatitis virus B (HBV) or C (HCV). HCC tumor onset and progression is a serial and heterogeneous process in which intrinsic factors, such as genetic mutations and chromosomal instability, are closely associated with an immunosuppressive tumor microenvironment (TME), which may have features associated with the etiopathogenesis and expression of the viral antigens, which favor the evasion of tumor neoantigens to immune surveillance. With the introduction of direct-acting antiviral (DAA) therapies for HCV infection, sustained virological response (SVR) has become very high, although occurrence of HCC and reactivation of HBV in patients with co-infection, who achieved SVR in short term, have been observed in a significant proportion of treated cases. In this review, we discuss the main molecular and TME features that are responsible for HCC pathogenesis and progression. Peculiar functional aspects that could be related to the presence and treatment of HCV/HBV viral infections are also dealt with.
Collapse
|
14
|
Katabathina VS, Marji H, Khanna L, Ramani N, Yedururi S, Dasyam A, Menias CO, Prasad SR. Decoding Genes: Current Update on Radiogenomics of Select Abdominal Malignancies. Radiographics 2021; 40:1600-1626. [PMID: 33001791 DOI: 10.1148/rg.2020200042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Technologic advances in chromosomal analysis and DNA sequencing have enabled genome-wide analysis of cancer cells, yielding considerable data on the genetic basis of malignancies. Evolving knowledge of tumor genetics and oncologic pathways has led to a better understanding of histopathologic features, tumor classification, tumor biologic characteristics, and imaging findings and discovery of targeted therapeutic agents. Radiogenomics is a rapidly evolving field of imaging research aimed at correlating imaging features with gene mutations and gene expression patterns, and it may provide surrogate imaging biomarkers that may supplant genetic tests and be used to predict treatment response and prognosis and guide personalized treatment options. Multidetector CT, multiparametric MRI, and PET with use of multiple radiotracers are some of the imaging techniques commonly used to assess radiogenomic associations. Select abdominal malignancies demonstrate characteristic imaging features that correspond to gene mutations. Recent advances have enabled us to understand the genetics of steatotic and nonsteatotic hepatocellular adenomas, a plethora of morphologic-molecular subtypes of hepatic malignancies, a variety of clear cell and non-clear cell renal cell carcinomas, a myriad of hereditary and sporadic exocrine and neuroendocrine tumors of the pancreas, and the development of targeted therapeutic agents for gastrointestinal stromal tumors based on characteristic KIT gene mutations. Mutations associated with aggressive phenotypes of these malignancies can sometimes be predicted on the basis of their imaging characteristics. Radiologists should be familiar with the genetics and pathogenesis of common cancers that have associated imaging biomarkers, which can help them be integral members of the cancer management team and guide clinicians and pathologists. Online supplemental material is available for this article. ©RSNA, 2020 See discussion on this article by Luna (pp 1627-1630).
Collapse
Affiliation(s)
- Venkata S Katabathina
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., H.M., L.K.); Departments of Radiology (S.Y., S.R.P.) and Pathology (N.R.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Haneen Marji
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., H.M., L.K.); Departments of Radiology (S.Y., S.R.P.) and Pathology (N.R.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Lokesh Khanna
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., H.M., L.K.); Departments of Radiology (S.Y., S.R.P.) and Pathology (N.R.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Nisha Ramani
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., H.M., L.K.); Departments of Radiology (S.Y., S.R.P.) and Pathology (N.R.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Sireesha Yedururi
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., H.M., L.K.); Departments of Radiology (S.Y., S.R.P.) and Pathology (N.R.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Anil Dasyam
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., H.M., L.K.); Departments of Radiology (S.Y., S.R.P.) and Pathology (N.R.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Christine O Menias
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., H.M., L.K.); Departments of Radiology (S.Y., S.R.P.) and Pathology (N.R.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Srinivasa R Prasad
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., H.M., L.K.); Departments of Radiology (S.Y., S.R.P.) and Pathology (N.R.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.D.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| |
Collapse
|
15
|
Barcena-Varela M, Lujambio A. The Endless Sources of Hepatocellular Carcinoma Heterogeneity. Cancers (Basel) 2021; 13:2621. [PMID: 34073538 PMCID: PMC8198457 DOI: 10.3390/cancers13112621] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 12/24/2022] Open
Abstract
Hepatocellular carcinoma (HCC) represents a global health problem. The incidence keeps increasing and current therapeutic options confer limited benefits to the patients. Tumor heterogeneity plays a central role in this context, limiting the availability of predictive biomarkers and complicating the criteria used to choose the most suitable therapeutic option. HCC heterogeneity occurs at different levels: within the population (inter-patient heterogeneity) and within tumors from the same patient (intra-patient and intra-tumor heterogeneity). Experts in the field have made many efforts to classify the patients based on clinicopathological characteristics and molecular signatures; however, there is still much work ahead to be able to integrate the extra-tumor heterogeneity that emerges from the complexity of the tumor microenvironment, which plays a critical role in the pathogenesis of the disease and therapy responses. In this review, we summarize tumor intrinsic and extrinsic sources of heterogeneity of the most common etiologies of HCC and summarize the most recent discoveries regarding the evolutionary trajectory of liver cancer cells and the influence of tumor-extrinsic factors such as the microbiome and the host immune system. We further highlight the potential of novel high-throughput methodologies to contribute to a better understanding of this devastating disease and to the improvement of the clinical management of patients.
Collapse
Affiliation(s)
- Marina Barcena-Varela
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
- Liver Cancer Program, Division of Liver Diseases, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- The Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Amaia Lujambio
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
- Liver Cancer Program, Division of Liver Diseases, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- The Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Graduate School of Biomedical Sciences at Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| |
Collapse
|
16
|
Beta-catenin-activated hepatocellular adenoma in a male. Clin J Gastroenterol 2021; 14:831-835. [PMID: 33651269 DOI: 10.1007/s12328-021-01372-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/22/2021] [Indexed: 01/14/2023]
Abstract
Beta-catenin-activated hepatocellular adenoma is potentially malignant and warrants careful follow-up and surgical resection. Here, we report a 48-year-old man in whom a 55 mm single liver tumor was incidentally detected in the S1 segment. Contrast-enhanced computed tomography scans showed no enhancement in the early phase and a slight defection in the late phase. The tumor was enhanced hyperintensity in the hepatobiliary phase on Gd-ethoxybenzyl-diethylenetriaminepentaacetic acid-enhanced magnetic resonance imaging. The histologic features of ultrasound-guided fine-needle aspiration biopsy indicated hepatocellular adenoma, and the tumor was immunohistochemically positive for glutamine synthetase and β-catenin. Considering the risk of malignant transformation, he underwent laparoscopic-assisted partial liver resection. The resected tumor did not contain any malignant lesions. This case indicates that aspiration needle biopsy and immunohistochemistry were useful for histological diagnosis and treatment decisions based on the molecular definition of hepatocellular adenoma.
Collapse
|
17
|
Shafaee Z, Liu S, Fiel MI, Blue R. Giant pedunculated hepatocellular adenoma masquerading as a subdiaphragmatic mass: Diagnostic challenges of a rare tumor. Radiol Case Rep 2021; 16:84-89. [PMID: 33193934 PMCID: PMC7644822 DOI: 10.1016/j.radcr.2020.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 11/28/2022] Open
Abstract
Giant pedunculated hepatocellular adenomas are extremely rare tumors and often detected incidentally on cross-sectional imaging studies. We report the case of a 34-year-old woman who underwent cross-sectional imaging for staging evaluation of a uterine tumor. A large left subdiaphragmatic mass, without clear connection to the liver, was seen prompting diagnostic laparoscopy; during which a large pedunculated mass attached to the left lobe of the liver was found and resected. This case report highlights the challenges and pitfalls in the imaging diagnosis of pedunculated hepatocellular adenomas, such as difficulty in characterizing the mass or inability to identify the vascular attachment to the liver. Image-guided biopsy and diagnostic laparoscopy are valuable tools to establish diagnosis; most of these lesions are amenable to laparoscopic resection.
Collapse
Affiliation(s)
- Zahra Shafaee
- Department of Surgery, NYC Health + Hospitals/Elmhurst, 79-01 Broadway, Elmhurst, NY 11373, USA
| | - Shaojun Liu
- Department of Pathology, NYC Health + Hospitals/Elmhurst, 79-01 Broadway, Elmhurst, NY 11373, USA
| | - Maria Isabel Fiel
- Department of Pathology, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Pl, New York, NY 10029, USA
| | - Robert Blue
- Department of Radiology, NYC Health + Hospitals/Elmhurst, 79-01 Broadway, Elmhurst, NY 11373, USA
| |
Collapse
|
18
|
Reizine E, Ronot M, Ghosn M, Calderaro J, Frulio N, Bioulac-Sage P, Trillaud H, Vilgrain V, Paradis V, Luciani A. Hepatospecific MR contrast agent uptake on hepatobiliary phase can be used as a biomarker of marked β-catenin activation in hepatocellular adenoma. Eur Radiol 2020; 31:3417-3426. [PMID: 33146794 DOI: 10.1007/s00330-020-07434-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/01/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To assess the value of hepatospecific MR contrast agent uptake on hepatobiliary phase (HBP) images to detect marked activation of the β-catenin pathway in hepatocellular adenomas (HCAs). METHODS This multicentric retrospective IRB-approved study included all patients with a pathologically proven HCA who underwent gadobenate dimeglumine-enhanced liver MRI with HBP. Tumor signal intensity on HBP was first assessed visually, and lesions were classified into three distinct groups-hypointense, isointense, or hyperintense-according to the relative signal intensity to liver. Uptake was then quantified using the lesion-to-liver contrast enhancement ratio (LLCER). Finally, the accuracy of HBP analysis in depicting marked β-catenin activation in HCA was evaluated. RESULTS A total of 124 HCAs were analyzed including 12 with marked β-catenin activation (HCA B+). Visual analysis classified 94/124 (76%), 12/124 (10%), and 18/124 (14%) HCAs as being hypointense, isointense, and hyperintense on HBP, respectively. Of these, 1/94 (1%), 3/12 (25%), and 8/18 (44%) were HCA B+, respectively (p < 0.001). The LLCER of HCA B+ was higher than that of HCA without marked β-catenin activation in the entire cohort (means 4.9 ± 11.8% vs. - 19.8 ± 11.4%, respectively, p < 0.001). A positive LLCER, i.e., LLCER ≥ 0%, had 75% (95% CI 43-95%) sensitivity and 97% (95% CI 92-99%) specificity, with a LR+ of 28 (95% CI 8.8-89.6) for the diagnosis of HCA B+. CONCLUSIONS Hepatospecific contrast uptake on hepatobiliary phase is strongly associated with marked activation of the β-catenin pathway in hepatocellular adenoma, and its use might improve hepatocellular adenoma subtyping on MRI. KEY POINTS • Tumor uptake on hepatobiliary phase in both the visual and quantitative analyses had a specificity higher than 90% for the detection of marked β-catenin activation in hepatocellular adenoma. • However, the sensitivity of visual analysis alone is inferior to that of LLCER quantification on HBP due to the high number of HCAs with signal hyperintensity on HBP, especially those developed on underlying liver steatosis.
Collapse
Affiliation(s)
- E Reizine
- Department of Radiology, APHP, HU Henri Mondor, Créteil, Val-de-Marne, France.
| | - M Ronot
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France
| | - M Ghosn
- Department of Radiology, APHP, HU Henri Mondor, Créteil, Val-de-Marne, France
| | - J Calderaro
- Department of Pathology, APHP, HU Henri Mondor, Créteil, Val-de-Marne, France.,Faculté de Médecine, Universite Paris Est Creteil, 94010, Créteil, France.,INSERM Unit U 955, Equipe 18, 94010, Créteil, France
| | - N Frulio
- CHU Bordeaux Department of Diagnostic and Interventional Radiology, Université de Bordeaux, 33000, Bordeaux, France
| | - P Bioulac-Sage
- Inserm, UMR1053 Bordeaux Research in Translational Oncology, BaRITOn, Université de Bordeaux, 33076, Bordeaux, France.,Department of Pathology, Pellegrin Hospital, CHU de Bordeaux, 33076, Bordeaux, France
| | - H Trillaud
- Department of Pathology, Beaujon Hospital, APHP, Clichy, France
| | - V Vilgrain
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France
| | - V Paradis
- INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France.,Department of Pathology, Beaujon Hospital, APHP, Clichy, France
| | - A Luciani
- Department of Radiology, APHP, HU Henri Mondor, Créteil, Val-de-Marne, France.,Faculté de Médecine, Universite Paris Est Creteil, 94010, Créteil, France.,INSERM Unit U 955, Equipe 18, 94010, Créteil, France
| |
Collapse
|
19
|
Krause K, Tanabe KK. A Shifting Paradigm in Diagnosis and Management of Hepatic Adenoma. Ann Surg Oncol 2020; 27:3330-3338. [PMID: 32542565 DOI: 10.1245/s10434-020-08580-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND New insights into molecular pathogenesis of hepatocellular adenomas (HCA) have allowed sub-classification based on distinct genetic alterations and a fresh look at characterizations of natural history. Clinically, this is important in understanding risk factors for two feared complications: malignant transformation and hemorrhage. METHODS PubMed literature search for hepatocellular adenoma over all years, excluding case reports and articles focusing on multiple adenomas or adenomatosis. RESULTS The β-catenin exon 3 mutated HCA accounts for about 10% of all HCAs and is associated with the highest risk of malignant transformation. The HF1α subtype accounts for 30-40% of all HCAs and has the lowest risk of malignant transformation. Gender has also emerged as an increasingly important risk factor and males with HCA are at considerably higher risk of malignant transformation, regardless of tumor size. The increasing use of gadoxetic-enhanced MRI has allowed for improved differentiation of HCAs from focal nodular hyperplasia, as well as the identification of specific radiologic features of some subtypes, particularly the inflammatory and HF1α HCAs. CONCLUSIONS Classification of HCA by subtype has important implications for patient counseling and treatment given variable risks of malignant transformation and hemorrhage. Males and those with β-catenin exon 3 mutated HCAs are two groups who should always be counselled to undergo surgical resection. On the other hand, in the lower risk HF1α subtype observation is appropriate in lesions < 5 cm and may even be considered in larger lesions as longer follow-up data is aggregated and tumorigenesis is better understood.
Collapse
Affiliation(s)
- Kate Krause
- Division of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kenneth K Tanabe
- Division of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
20
|
Hahn E, Putra J. Hepatocellular adenoma in the paediatric population: Molecular classification and clinical associations. World J Gastroenterol 2020; 26:2294-2304. [PMID: 32476794 PMCID: PMC7243640 DOI: 10.3748/wjg.v26.i19.2294] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/29/2020] [Accepted: 04/30/2020] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular adenomas (HCAs) represent rare, benign liver tumours occurring predominantly in females taking oral contraceptives. In children, HCAs comprise less than 5% of hepatic tumours and demonstrate association with various conditions. The contemporary classification of HCAs, based on their distinctive genotypes and clinical phenotypes, includes hepatocyte nuclear factor 1 homeobox alpha-inactivated HCAs, beta-catenin-mutated HCAs, inflammatory HCAs, combined beta-catenin-mutated and inflammatory HCAs, sonic hedgehog-activated HCAs, and unclassified HCAs. In children, there is a lack of literature on the characteristics and distribution of HCA subtypes. In this review, we summarized different HCA subtypes and the clinicopathologic spectrum of HCAs in the paediatric population.
Collapse
Affiliation(s)
- Elan Hahn
- Division of Pathology, Department of Paediatric Laboratory Medicine, the Hospital for Sick Children, Toronto M5G 1X8, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto M5S 1A8, ON, Canada
| | - Juan Putra
- Division of Pathology, Department of Paediatric Laboratory Medicine, the Hospital for Sick Children, Toronto M5G 1X8, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto M5S 1A8, ON, Canada
| |
Collapse
|
21
|
Hepatobiliary MRI Contrast Agents: Pattern Recognition Approach to Pediatric Focal Hepatic Lesions. AJR Am J Roentgenol 2020; 214:976-986. [DOI: 10.2214/ajr.19.22239] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
22
|
Sala M, Gonzales D, Leste‐Lasserre T, Dugot‐Senant N, Paradis V, Di Tommaso S, Dupuy J, Pitard V, Dourthe C, Sciarra A, Sempoux C, Ferrell LD, Clouston AD, Miller G, Yeh MM, Thung S, Gouw AS, Quaglia A, Han J, Huan J, Fan C, Crawford J, Nakanuma Y, Harada K, le Bail B, Castain C, Frulio N, Trillaud H, Possenti L, Blanc J, Chiche L, Laurent C, Balabaud C, Bioulac‐Sage P, Raymond AA, Saltel F. ASS1 Overexpression: A Hallmark of Sonic Hedgehog Hepatocellular Adenomas; Recommendations for Clinical Practice. Hepatol Commun 2020; 4:809-824. [PMID: 32490318 PMCID: PMC7262286 DOI: 10.1002/hep4.1514] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/14/2020] [Accepted: 02/17/2020] [Indexed: 12/17/2022] Open
Abstract
Until recently, 10% of hepatocellular adenomas (HCAs) remained unclassified (UHCA). Among the UHCAs, the sonic hedgehog HCA (shHCA) was defined by focal deletions that fuse the promoter of Inhibin beta E chain with GLI1. Prostaglandin D2 synthase was proposed as immunomarker. In parallel, our previous work using proteomic analysis showed that most UHCAs constitute a homogeneous subtype associated with overexpression of argininosuccinate synthase (ASS1). To clarify the use of ASS1 in the HCA classification and avoid misinterpretations of the immunohistochemical staining, the aims of this work were to study (1) the link between shHCA and ASS1 overexpression and (2) the clinical relevance of ASS1 overexpression for diagnosis. Molecular, proteomic, and immunohistochemical analyses were performed in UHCA cases of the Bordeaux series. The clinico‐pathological features, including ASS1 immunohistochemical labeling, were analyzed on a large international series of 67 cases. ASS1 overexpression and the shHCA subgroup were superimposed in 15 cases studied by molecular analysis, establishing ASS1 overexpression as a hallmark of shHCA. Moreover, the ASS1 immunomarker was better than prostaglandin D2 synthase and only found positive in 7 of 22 shHCAs. Of the 67 UHCA cases, 58 (85.3%) overexpressed ASS1, four cases were ASS1 negative, and in five cases ASS1 was noncontributory. Proteomic analysis performed in the case of doubtful interpretation of ASS1 overexpression, especially on biopsies, can be a support to interpret such cases. ASS1 overexpression is a specific hallmark of shHCA known to be at high risk of bleeding. Therefore, ASS1 is an additional tool for HCA classification and clinical diagnosis.
Collapse
Affiliation(s)
- Margaux Sala
- BaRITOn Bordeaux Research in Translational OncologyUniversity of BordeauxINSERMUMR1053BordeauxFrance
| | | | | | | | - Valérie Paradis
- INSERM; APHP, Pathology DepartmentBeaujon HospitalUniversité de Paris Hopital BeaujonClichyFrance
| | - Sylvaine Di Tommaso
- BaRITOn Bordeaux Research in Translational OncologyUniversity of BordeauxINSERMUMR1053BordeauxFrance
- Plateforme OncoprotTBM‐Core US 005BordeauxFrance
| | - Jean‐William Dupuy
- Plateforme ProtéomeCentre de Génomique FonctionnelleUniversity of BordeauxBordeauxFrance
| | - Vincent Pitard
- ImmunoConceptCNRS UMR 5164University of BordeauxBordeauxFrance
| | - Cyril Dourthe
- BaRITOn Bordeaux Research in Translational OncologyUniversity of BordeauxINSERMUMR1053BordeauxFrance
- Plateforme OncoprotTBM‐Core US 005BordeauxFrance
| | - Amedeo Sciarra
- Service of Clinical PathologyInstitute of PathologyLausanne University HospitalUniversity of LausanneLausanneSwitzerland
| | - Christine Sempoux
- Service of Clinical PathologyInstitute of PathologyLausanne University HospitalUniversity of LausanneLausanneSwitzerland
| | | | - Andrew D. Clouston
- Centre for Liver Disease ResearchSchool of MedicineUniversity of QueenslandBrisbaneQLDAustralia
| | - Gregory Miller
- Centre for Liver Disease ResearchSchool of MedicineUniversity of QueenslandBrisbaneQLDAustralia
| | - Mathew M. Yeh
- University of Washington School of MedicineSeattleWA
| | - Swan Thung
- Icahn School of Medicine at Mount SinaiNew YorkNY
| | - Annette S.H. Gouw
- Department of PathologyUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Alberto Quaglia
- Department of Cellular PathologyRoyal Free London NHS Foundation TrustLondonUnited Kingdom
| | - Jing Han
- Department of PathologyZhongshan HospitalFudan UniversityShanghaiChina
| | - Ji Huan
- Department of PathologyZhongshan HospitalFudan UniversityShanghaiChina
| | - Cathy Fan
- Department of Pathology and Laboratory MedicineHofstra/NorthwellHempsteadNY
| | - James Crawford
- Department of Pathology and Laboratory MedicineHofstra/NorthwellHempsteadNY
| | | | - Kenichi Harada
- Department of Human PathologyKanazawa University Graduate School of Medical SciencesKanazawaJapan
| | - Brigitte le Bail
- BaRITOn Bordeaux Research in Translational OncologyUniversity of BordeauxINSERMUMR1053BordeauxFrance
- Department of PathologyCHU BordeauxBordeauxFrance
| | | | - Nora Frulio
- Department of Diagnostic and Interventional RadiologyCHU BordeauxBordeauxFrance
| | - Hervé Trillaud
- Department of Diagnostic and Interventional RadiologyCHU BordeauxBordeauxFrance
- EA ImotionUniversity of BordeauxBordeauxFrance
| | - Laurent Possenti
- Department of Hepatology and OncologyINSERM CIC1401CHU BordeauxBordeauxFrance
| | - Jean‐Frédéric Blanc
- BaRITOn Bordeaux Research in Translational OncologyUniversity of BordeauxINSERMUMR1053BordeauxFrance
- Department of Hepatology and OncologyINSERM CIC1401CHU BordeauxBordeauxFrance
| | | | | | - Charles Balabaud
- BaRITOn Bordeaux Research in Translational OncologyUniversity of BordeauxINSERMUMR1053BordeauxFrance
| | - Paulette Bioulac‐Sage
- BaRITOn Bordeaux Research in Translational OncologyUniversity of BordeauxINSERMUMR1053BordeauxFrance
| | - Anne Aurélie Raymond
- BaRITOn Bordeaux Research in Translational OncologyUniversity of BordeauxINSERMUMR1053BordeauxFrance
- Plateforme OncoprotTBM‐Core US 005BordeauxFrance
| | - Frédéric Saltel
- BaRITOn Bordeaux Research in Translational OncologyUniversity of BordeauxINSERMUMR1053BordeauxFrance
- Plateforme OncoprotTBM‐Core US 005BordeauxFrance
| |
Collapse
|
23
|
Agostini CH, Ribeiro OD, Fernandes A, Caroli-Bottino A, Pannain VL. Relevance of morphological features for hepatocellular adenoma classification in pathology practice. SURGICAL AND EXPERIMENTAL PATHOLOGY 2020. [DOI: 10.1186/s42047-020-00061-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Gene mutations correlated with histological and immunohistochemical phenotypes of hepatocellular adenoma were recently identified. Based on these findings, four adenoma subtypes were distinguished. We classify hepatocellular adenoma (HCA) into subtypes based on histologic and immunohistochemical findings and verify the contribution of histological features in pathology practice.
Methods
Thirty hepatocellular adenomas were classified in subtypes. Sinusoidal dilatation, ductular reaction, pseudoportal tracts, pseudoglands, steatosis, inflammatory infiltrate and cellular atypia were analyzed, as well as liver fatty acid binding protein, β catenin, serum amyloid A, glutamine synthetase, and C-reactive protein antibodies.
Results
Histologically, eleven adenomas were classified as HNF1A inactivated (HHCA), five were β-catenin-activated (bHCA) and fourteen were inflammatory adenoma (IHCA). Steatosis was found in all HHCA and was predominantly severe. Sinusoidal dilatation and inflammatory infiltrate were present in all IHCA. Ductular reaction, pseudoportal tracts and cellular atypia were observed in 71.4, 85.7 and 42.8%, respectively. Pseudoglands were present in 60% and cellular atypia in 80% of bHCA. According to immunohistochemistry, 11 were HHCA; 1 was bHCA; 17 were IHCA, among which 5 were β-catenin activated IHCA; and 1 was unclassified UHCA (UHCA). Superior concordance between the histological and immunohistochemical classifications was found for HHCA (К = 0.854) and IHCA (К = 0.657).
Conclusion
Approximately 90% of adenomas may be diagnosed by subgroup based only on morphological features. When aberrant β catenin nuclear staining is not found, glutamine synthetase positivity is useful for diagnosis, although supplementary molecular analysis may be necessary.
Collapse
|
24
|
Sanford B, Hoeppner C, Ju T, Theisen BK, BuAbbud A, Estroff JM. Multidisciplinary management of the pregnant patient in haemorrhagic shock secondary to an undiagnosed ruptured liver adenoma. BMJ Case Rep 2020; 13:13/2/e231995. [PMID: 32060109 DOI: 10.1136/bcr-2019-231995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Management of a ruptured hepatocellular adenoma during pregnancy is a rare and potentially life-threatening entity. Few case reports have described management of the pregnant patient who presents in haemorrhagic shock secondary to a ruptured liver adenoma. A 30-year-old primigravid woman at 31 weeks pregnant presented with abdominal pain and fetal bradycardia. After stat caesarean delivery of the infant, she had continued hemoperitoneum and was in shock secondary to an undiagnosed ruptured liver mass. General surgery was consulted intraoperatively and performed an exploratory laparotomy, packing and temporary closure. She was subsequently taken to interventional radiology (IR) for angioembolisation of the left hepatic artery. After stabilisation, she underwent formal abdominal closure. Management of a ruptured hepatocellular adenoma in pregnancy requires urgent multidisciplinary care including obstetrics gynaecology, general surgery and IR.
Collapse
Affiliation(s)
- Brittany Sanford
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Catherine Hoeppner
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC, USA
| | - Tammy Ju
- Department of Surgery, George Washington University, Washington, DC, USA
| | - Brian K Theisen
- Department of Pathology, George Washington University, Washington, DC, USA
| | - Anna BuAbbud
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC, USA
| | - Jordan M Estroff
- Department of Surgery, George Washington University, Washington, DC, USA
| |
Collapse
|
25
|
Nahm CB, Parker N, Gundara JS, Gill AJ, Bhimani N, Samra JS, Hugh TJ. Management of patients with hepatocellular adenoma: a single-institution experience. ANZ J Surg 2020; 90:786-790. [PMID: 31943651 DOI: 10.1111/ans.15648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/29/2019] [Accepted: 12/10/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hepatocellular adenoma (HCA) is a rare benign liver tumour that may cause diagnostic and management dilemmas. This study describes the clinical and histopathological characteristics of patients who were treated for HCA in a tertiary referral hospital over a 17-year period. METHODS A retrospective review was performed of prospectively collected data of all patients treated for HCA within the Northern Upper GI Surgical unit between 2002 and 2018. Immunohistochemical β-catenin expression was evaluated. RESULTS Thirty-two patients had histological or radiologically confirmed HCA. Twenty-eight patients underwent 30 operations and four patients were treated conservatively. The median age of the operative group was 43 years (range 19-83) and most patients were female (95%). The median body mass index was 28.7 (range 20-51), and nine patients (33%) were obese. Seven patients (25%) had multifocal HCA. Evidence of prior bleed or rupture or a perceived risk of either a bleed or malignant change (i.e. tumours ≥50 mm) were the most common indications for resection. There were no perioperative mortalities. Nuclear expression of β-catenin by immunohistochemical staining was negative in all cases and there was no malignancy identified in any of the resected lesions. Two patients required transarterial embolization and two patients required a second liver resection for residual HCA. CONCLUSION HCA is a rare lesion predominantly affecting females. Haemorrhage is seen frequently on imaging studies, occasionally requiring urgent angioembolization and/or surgical intervention. Malignant transformation and immunohistochemical β-catenin expression are uncommon. HCA may be multifocal and residual tumours usually require ongoing surveillance and occasionally further intervention.
Collapse
Affiliation(s)
- Christopher B Nahm
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Parker
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Justin S Gundara
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Anthony J Gill
- Cancer Diagnosis and Pathology Group, Kolling Institute, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Nazim Bhimani
- Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Jaswinder S Samra
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Thomas J Hugh
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
26
|
Zulfiqar M, Sirlin CB, Yoneda N, Ronot M, Hecht EM, Chernyak V, Matsui O, Bastati N, Ba‐Ssalamah A, Chatterjee D, Bashir M, Fowler KJ. Hepatocellular adenomas: Understanding the pathomolecular lexicon, MRI features, terminology, and pitfalls to inform a standardized approach. J Magn Reson Imaging 2019; 51:1630-1640. [DOI: 10.1002/jmri.26902] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 12/15/2022] Open
Affiliation(s)
- Maria Zulfiqar
- Mallinckrodt Institute of RadiologyWashington University School of Medicine St Louis Missouri USA
| | - Claude B. Sirlin
- Department of RadiologyUniversity of California San Diego San Diego California USA
| | | | - Maxime Ronot
- Department of RadiologyHôpitaux Universitaires Paris Nord Val de Seine, Cinchy France
| | | | - Victoria Chernyak
- Department of Radiology, Montefiore Medical CenterAlbert Einstein College of Medicine New York New York USA
| | - Osamu Matsui
- Department of RadiologyKanazawa University Japan
| | - Nina Bastati
- Department of Biomedical Imaging and Image‐guided therapyMedical University of Vienna Vienna Austria
| | - Ahmed Ba‐Ssalamah
- Department of Biomedical Imaging and Image‐guided therapyMedical University of Vienna Vienna Austria
| | - Deyali Chatterjee
- Department of PathologyWashington University School of Medicine St Louis Missouri USA
| | - Mustafa Bashir
- Department of RadiologyDuke University Durham North Carolina USA
| | - Kathryn J. Fowler
- Department of RadiologyUniversity of California San Diego San Diego California USA
| |
Collapse
|
27
|
Geramizadeh B, Memar Z, Malekhosseini S. Immunohistochemical Classification of Hepatic Adenoma, A Single Center Experience. HEPATITIS MONTHLY 2019; 19. [DOI: 10.5812/hepatmon.91641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/15/2019] [Accepted: 06/17/2019] [Indexed: 08/30/2023]
|