Molecular classification of hepatocellular adenomas: impact on clinical practice

Védie, Anne-Laure; Ziol, Marianne; Nault, Jean‐Charles

doi:10.2217/hep-2017-0023

Cited by 41 publications

(29 citation statements)

References 68 publications

(117 reference statements)

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“…The Bordeaux classification identifies multiple HCA subtypes linked to risk factors, histology and imaging and clinical factors . These include HNF‐1α‐mutated HCA, inflammatory HCA, β‐catenin‐activated HCA mutated in exon 3, β‐catenin‐activated HCA mutated in exon 7–8, sonic hedgehog HCA and unclassified HCA.…”

Section: Discussionmentioning

confidence: 99%

“…While it would have been interesting to categorize our patients based on the Bordeaux classification, other than for β‐catenin immunohistochemistry, this was beyond the scope of this study. β‐catenin‐activated HCA mutated in exon 3 make up approximately 7% of all adenomas and are associated with the highest risk of malignant transformation …”

Section: Discussionmentioning

confidence: 99%

“…Hepatocellular adenoma (HCA) is a rare benign tumour occurring mostly in women of childbearing age . Risk factors include long‐term oral contraceptive pill use, obesity, metabolic syndrome, long‐term use of anabolic steroids, hepatic vascular disease and glycogen storage disease . Complications occur predominantly in large lesions and these include spontaneous haemorrhage, rupture and malignant change .…”

Section: Introductionmentioning

confidence: 99%

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Management of patients with hepatocellular adenoma: a single‐institution experience

Nahm

Parker

Gundara

et al. 2020

ANZ Journal of Surgery

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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 Gastrointestinal Surgical Unit between 2002 and 2018. Immunohistochemical β-catenin expression was evaluated. Results: Thirty-two patients had histological or radiologically confirmed HCA. Twentyeight 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.© 2020 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 786-790ANZJSurg.com

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Management of patients with hepatocellular adenoma: a single‐institution experience

Nahm

Parker

Gundara

et al. 2020

ANZ Journal of Surgery

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“…Pregnancy is also associated with the potentiation of hepatocellular adenomas due to elevated oestrogen levels, which can promote further growth and potential rupture. The two main concerns with a hepatocellular adenoma are symptomatic haemorrhage (15%–20%) and malignant transformation into a hepatocellular carcinoma (<5%) 3. Mortality rates related to ruptured liver adenoma in pregnancy can range up to 50% due to haemorrhagic shock 1 4.…”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary management of the pregnant patient in haemorrhagic shock secondary to an undiagnosed ruptured liver adenoma

Sanford

Hoeppner

et al. 2020

BMJ Case Rep

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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.

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“…Accordingly, loss of liver fatty acid binding protein (LFABP), aberrant expression of C‐reactive protein (CRP), and glutamine synthase (GS) are used to identify H‐HCA, IHCA, b‐HCA and b‐IHCA, respectively. ( 13‐17 ) Until now, HCAs were classified as UHCAs when all of these immunohistochemical markers were negative.…”

mentioning

confidence: 99%

ASS1 Overexpression: A Hallmark of Sonic Hedgehog Hepatocellular Adenomas; Recommendations for Clinical Practice

et al. 2020

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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.

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Molecular classification of hepatocellular adenomas: impact on clinical practice

Cited by 41 publications

References 68 publications

Management of patients with hepatocellular adenoma: a single‐institution experience

Management of patients with hepatocellular adenoma: a single‐institution experience

Multidisciplinary management of the pregnant patient in haemorrhagic shock secondary to an undiagnosed ruptured liver adenoma

ASS1 Overexpression: A Hallmark of Sonic Hedgehog Hepatocellular Adenomas; Recommendations for Clinical Practice

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