Hepatocellular adenoma classification: a comparative evaluation of immunohistochemistry and targeted mutational analysis

Margolskee, Elizabeth; Bao, Fei; González, Anne Koehne de; Moreira, Roger K.; Lagana, Stephen M.; Sireci, Anthony; Sepulveda, Antonia R.; Remotti, Helen; Lefkowitch, Jay H.; Salomao, Marcela A.

doi:10.1186/s13000-016-0475-5

Cited by 36 publications

(28 citation statements)

References 38 publications

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“…We presented the case of a young woman with a history of oral contraceptive use who initially presented with discrete symptoms and an ultrasonography result suggestive of a liver lesion. It is known that HCA affects mainly women using oral contraceptives [ 3 ], in keeping with our patient.…”

Section: Discussionsupporting

confidence: 84%

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Hepatocyte Nuclear Factor 1α-Mutated Hepatocellular Adenomas: An Atypical Presentation

Sousa

Gadelha

Cartaxo

et al. 2017

Case Rep Gastroenterol

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Hepatocellular adenomas (HCAs) are rare benign monoclonal hepatic tumors that commonly occur in females (3–4 per 100,000 women) due to the use of oral contraceptives, its primary risk factor. Recently, HCAs have been classified into 4 distinct subtypes according to genotypic and phenotypic characteristics and clinical features: inflammatory HCA (40–50%), which are hypervascular with marked peliosis and a tendency to bleed; hepatocyte nuclear factor 1α (HNF1A)-mutated HCA (H-HCA, 30–40%) that are diffusely steatotic and rarely undergo malignant transformation; β-catenin activated HCA (10–15%), which frequently undergo malignant transformation and may seem hepatocellular carcinoma on imaging; and unclassified HCA (10–25%). In this study, we report the case of a 23-year-old female oral contraceptive user with H-HCA. Usually, H-HCA is considered to be nonsevere in most cases and often requires outpatient follow-up. However, in this case, the injury had substantially increased in volume and evolved with a major bleeding frame, which was an unusual finding for this subtype of adenoma. The therapeutic used for this patient was a laparoscopic left hepatic segmentectomy. Thus, the choice of treatment to be performed in a patient with H-HCA can depend on the tumor size (>5 cm), the outcome of previous bleeding, and the risk of bleeding recurrence.

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Section: Discussionsupporting

confidence: 84%

“…Hepatocellular adenomas (HCAs) are rare monoclonal benign liver tumors that most commonly occur in women (3–4 per 100,000 women) [ 1 , 2 ]. HCAs are the third most prevalent benign tumors of the liver and have the capacity to undergo malignant transformation [ 2 , 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Hepatocyte Nuclear Factor 1α-Mutated Hepatocellular Adenomas: An Atypical Presentation

Sousa

Gadelha

Cartaxo

et al. 2017

Case Rep Gastroenterol

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“…However, as Table 4 shows there have been many controversial reports about the percentage of β-catenin mutated HCAs. Studies from the USA report the results of b-HCA from zero (2) to 15.4% (14) which can be secondary to variable ethnicity in this country. Studies from Japan are more consistent and two reported studies have had similar results around 15% (12, 13).…”

Section: Discussionmentioning

confidence: 91%

“…2019; 19(6):e91641. means that the issue is evolving and the difference in the frequencies is multifactorial, which emphasizes the importance of routine classification of the cases with the diagnosis of HCA (4,(12)(13)(14)(15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

Immunohistochemical Classification of Hepatic Adenoma, A Single Center Experience

2019

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Objectives: Hepatocellular adenoma (HCA) is a tumor with heterogenous molecular pathogenesis and varying malignant potential. Subclassification of HCAs is one of the important issues for the management decision to perform surgery or to follow up the patient. Iran is in intermediate status regarding the incidence of hepatocellular carcinoma, and on the other hand, incidence of viral precursors especially hepatitis B is decreasing, so it can be important to know the frequency of premalignant subtypes of liver cell adenomas in Iran. Methods: During the study period (10 years from 2008 to 2018) 40 cases of HCA (35 female and 5 males) were retrieved from the archives of the pathology departments of the affiliated hospitals of Shiraz University of Medical Sciences. The diagnosis was confirmed and the best paraffin block was used for IHC staining for liver fatty acid binding protein (LFABP), glutamine synthetase (GS), β-catenin and serum amyloid A (SAA). Histologic findings were also recorded. In the mean time, clinical charts of the patients were reviewed and clinicopathologic findings were compared. Results: The most common subtype in our cases was hepatocyte nuclear factor-1α inactivated and the least common was β-catenin activated subtype. We didn't find any cases of mixed subtype. Inflammatory subtype was seen in 10% of the cases. Another 10% of our cases were unclassified because all of the IHC markers were negative. Conclusions: Our results confirmed that immunohistochemistry should be routinely performed to subclassify HCAs. We also showed that frequencies of subtypes differ according to the studied population. For our population (Middle East or west Asia) HCAs with malignant potential are the least common.

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“…The histopathological and immunohistochemical analysis was done first, we attempted to classify each adenoma based on IHC pattern, as previously described (10 ). HA with strong and diffuse GS staining (score 2+) and/or β-catenin nuclear staining, regardless of the SAA staining status, were categorized as HA-B.…”

Section: Resultsmentioning

confidence: 99%

Hepatoselüler Adenoma Patolojisi: Alt Tipleri ve Nadir Görülen Morfolojik Özellikleri

Hayirlioğlu¹,

Fotioğlu²,

Kırımlıoğlu³

2020

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Background: The molecular classification has been divided HCA into four main subgroups: hepatocyte-nuclear-factor-1a mutated (H-HCA), B-catenin type (HA-B), inflammatory type (HA-I) and unclassified type. Those subgroups were linked with risk factors, clinical behavior, histological features, imaging and malignant transformation. Subtyping is useful to predict HA's behavior and also to detect morphology which may have the potential to affect the prognosis. We aimed to review subtype features of our hepatocellular adenoma cases and discuss the importance of the rare morphologic features. Methods: Fifteen Hepatocellular adenoma cases (10 resections, 3 explants and 2 biopsies) were included in this study. Hematoxylin and eosin (H&E) stained slides, Reticulin and Masson's trichrome stains, as well as immunohistochemical studies (IHC), were used to evaluate general morphologic and immunophenotypic features performed with B-catenin, SAA amyloid and Glutamine Synthetase(GS) using standard laboratory techniques in the Ventana Benchmark Ultra platform. CD34 immunohistochemical stains were performed on atypical cases to evaluate the presence of vascularization. Results: By morphologic features and Immunohistochemistry, 3 HA-B (%20), 4 HA-I (%26.6), 4 HA-H (%26.6) and 4 HA-U (%26.6) cases were classified. Two HA cases had Dubin-Johnson pigment and Two of the beta-catenin mutated HAs had bone marrow metaplasia. In one of the cases, malignant transformation in the HA was present. The microscopic findings included hemorrhage, pigment formation, granuloma formation, presence of inflammation, presence and degree of steatosis, preserved or non-preserved reticulin network. Conclusions: Besides the classic morphologic features; granuloma formation, pigmentation, bone marrow metaplasia can be seen in HAs. Although the prognostic significance of those is not known, they are considered to have a role in the development and progression of HA.

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Hepatocellular adenoma classification: a comparative evaluation of immunohistochemistry and targeted mutational analysis

Cited by 36 publications

References 38 publications

Hepatocyte Nuclear Factor 1α-Mutated Hepatocellular Adenomas: An Atypical Presentation

Hepatocyte Nuclear Factor 1α-Mutated Hepatocellular Adenomas: An Atypical Presentation

Immunohistochemical Classification of Hepatic Adenoma, A Single Center Experience

Hepatoselüler Adenoma Patolojisi: Alt Tipleri ve Nadir Görülen Morfolojik Özellikleri

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