A Case of Hepatocellular Carcinoma Within Hepatocellular Adenoma in a Non-Cirrhotic Male

Abstract

Hepatocellular adenoma (HA) is a benign hepatic lesion that predominantly occurs in young women. Most hepatocellular carcinomas (HCC) arise in a cirrhotic liver during the fifth or sixth decades. There have been several reported cases of HCC developing from HA in female patients. However, there are rare cases about HCC arising in HA in a non-cirrhotic male patient. We have recently encountered a 53-year-old man who had a liver mass in a non-cirrhotic liver, and the liver mass was compatible with HA on the pre-operative computed tomography. The mass was completely resected and the histopathology revealed a focus of HCC arising in HA. We report here on this case along with a brief review of the relevant literature.

Clinicopathologic analysis of the simple nodular type of well‐differentiated hepatocellular carcinoma with extensive peliotic change

“…In HCC, approximately 40% of HCCs with high histological grade also had PC as we previously reported . Immunohistochemical staining for cytokeratin 8 or 18 and endothelial cell markers such as CD31, CD34, factor VIII, and von Willebrand factor have been shown to be useful for distinguishing PHCC from vascular neoplasms occurring in the liver such as hemangioma or angiosarcoma …”

Malignant transformation of hepatocellular adenomas into hepatocellular carcinomas: a systematic review including more than 1600 adenoma cases

“…Most cases of malignant transformation of HCAs were seen at the time of the diagnosis of HCA. Furthermore, only three cases (16%) among these 19 cases of malignant degeneration presented with multiple HCAs 19–21 and six cases (32%) were complicated by haemorrhage 21–26 …”

“…In this study, only one case of malignant transformation was observed in an adenoma measuring less than 5 cm in diameter (2–5 cm, exact size not presented), concerning a male individual with a history of steroid intake. Overall, the current literature search showed that a total of three cases of malignant alteration (4.4% of all HCAs showing this phenomenon) occurred in a tumour measuring less than 5 cm in diameter 14,24,31 …”

“…Unfortunately, in the current study a true risk analysis based on tumour size was difficult to perform as many studies only reported the mean size of the adenomas included. However, as three cases have been reported in which malignant transformation occurred in a tumour measuring less than 5 cm in diameter, the recommendation to only treat HCAs larger than 5 cm in diameter in order to prevent malignant transformation is open for debate 14,24,31 …”

Hepatocellular carcinoma arising in adenoma: similar immunohistochemical and cytogenetic features in adenoma and hepatocellular carcinoma portions of the tumor

“…1,2,6–8 Both tumors occur concurrently in most reported cases, it has been assumed that this represents malignant transformation of an adenoma. 14–20 Some reports have mentioned hepatocellular carcinoma arising in adenomas in the setting of underlying diseases like hepatitis B; it is likely that the adenoma part was a high-grade dysplastic nodule or well-differentiated hepatocellular carcinoma. 21 Similarly, progression to hepatocellular carcinoma described in an adenoma where the latter diagnosis was based on a needle biopsy may have been an hepatocellular carcinoma at initial presentation that could not be diagnosed based on the biopsy specimen.…”