The Malignant Transformation of Liver Cell Adenomas

Foster, James H.

doi:10.1001/archsurg.1994.01420310044007

Cited by 189 publications

(94 citation statements)

References 17 publications

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“…In this series, 3/17 (18%) of hepatic adenomas showed the presence of carcinoma. By comparison, Foster and Berman 17 reported a 13% frequency of malignancy in 39 adenomas, whereas Closset et al 16 reported a frequency of 1/16 (6%) of adenomas with co-existing cancer and 2/16 (12%) with dysplasia. ZucmanRossi, in a multicenter study, found 5/93 (5%) of hepatic adenomas with malignant degeneration and 6/93 (6%) cases borderline for hepatocellular carcinoma.…”

Section: Discussionmentioning

confidence: 96%

Malignant transformation of hepatic adenomas

et al. 2008

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Hepatic adenomas are benign neoplasms of the liver that occur in several well-defined clinical settings, but principally that of excess hormone exposure. They have a small but poorly characterized risk of malignant degeneration. The clinical presentation and pathological findings were reviewed for all hepatic adenomas resected between January 1, 2003 and July 1, 2006. Immunohistochemistry for p53, b-catenin and a-fetoprotein (AFP) were performed on those cases with malignant transformation and exon 3 of b-catenin was amplified and sequenced. A total of 17 hepatic adenomas were resected and 3 showed malignant transformation. All three cases were in women with an age range of 23-33 years. The clinical presentations were vague abdominal pain. Histologically, the malignant transformation occurred within otherwise typical hepatic adenomas. Two of three cases showed patchy atypia throughout the hepatic adenoma. The hepatocellular carcinoma arose as distinct nodules directly within the adenomas, effectively ruling out synchronous lesions. The hepatocellular carcinomas were unifocal in two cases and multifocal in one case with the greatest dimensions of the hepatocellular carcinoma being 2.5, 2.2, and 1 cm. Immunostains for AFP and b-catenin were negative in both the hepatic adenomas and areas of hepatocellular carcinoma. p53 immunostaining was positive within the areas of malignant transformation in one case. No mutations or deletions were seen in exon 3 of the b-catenin gene for either the adenomas or the carcinoma. In conclusion, two of the cases that developed hepatocellular carcinomas showed cytological atypia in the background adenoma. The hepatocellular carcinomas arose as distinct nodules within the adenomas. No common molecular pathway of hepatocellular carcinogenesis was observed by examining AFP, b-catenin, and p53 immunostains and no b-catenin mutations or deletions were found.

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Section: Discussionmentioning

confidence: 96%

Malignant transformation of hepatic adenomas

et al. 2008

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“…To our knowledge, only one case of malignant transformation among patients with adenomatosis 4 and nine cases among patients with hepatic adenoma have been reported. 8,[30][31][32][33][34][35][36][37] Among 17 patients in the literature with LA in whom follow-up was available (mean follow-up, 30.8 months), 3 developed new benign lesions [27][28][29] and 1 developed HCC 4 ; however, in those reports, the follow-up was very short and imaging studies were not performed routinely during the follow-up period. Therefore, the true rate of appearance of new lesions is unknown.…”

Section: Discussionmentioning

confidence: 99%

Management of liver adenomatosis: Results with a conservative surgical approach

et al. 1998

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Liver adenomatosis is defined by the presence of multiple hepatic adenomas (more than three lesions). The natural history and treatment of liver adenomatosis are not yet well defined. The Mayo Clinic (Rochester, MN) experience with liver adenomatosis in the past 11 years was reviewed and a rational treatment approach is presented. Records from patients with liver adenomatosis and hepatic adenoma seen at the Mayo Clinic from January 1986 to June 1997 were reviewed. Estrogen-and progesterone-receptor status was assessed by immunohistochemistry. Eight women with liver adenomatosis were identified. All patients had undergone surgical treatment. Abdominal pain was the presenting symptom in 87.5% of the patients with adenomatosis and in 42.1% of the patients with hepatic adenoma. Tumor bleeding was present in 62.5% of the patients with adenomatosis and in 26.3% of the patients with hepatic adenomas. Bleeding occurred predominantly in lesions greater than 4 cm. All patients with liver adenomatosis reported improvement of symptoms after surgery, and the mean bleedingfree period after resection in 5 patients was 52.6 ؎ 23.6 months. In 6 patients, estrogen receptorpositive and estrogen receptor-negative tumors were identified in the same liver. Based on the good outcome after resection in symptomatic patients with liver adenomatosis, we recommend resection of large (H5 cm) or symptomatic lesions with observation of smaller lesions (I3 cm). Lack of estrogen receptors in many lesions suggests that estrogen does not play a dominant role in the pathogenesis of liver adenomatosis.

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“…22 In one series of 39 cases of unresected liver adenoma, 5 cases subsequently developed hepatocellular carcinoma. 23 Sometimes, hepatic adenoma is difficult to differentiate from well -differential hepatocellular carcinoma. Therefore surgery should be indicated when clinical diagnosis of hepatocellular carcinoma can't be ruled out or malignant transformation is suspected.…”

Section: Discussionmentioning

confidence: 99%

Hepatic Adenoma - A Case Report

et al. 2016

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We report the case of a 32-year-old female who presented to us with incidental findings of a space occupying lesion (SOL) in liver on abdominal ultrasound (USG). She was taking oral contraceptive pill for last 9 years. Clinical examination was unremarkable and liver investigation revealed mildly raised Serum alanine aminotrasferase (ALT). Dyslipidemia was also present. Computed tomography (CT) identified a 2.5 cm lesion in the right lobe of liver at posterior aspect which was isodense. Alpha-feto protein was normal. CT guided Fine Needle Aspiration Cytology (FNAC) showed adequate cellular material containing organized reactive hepatocytes in the background of blood. No granuloma or malignant cell was seen. Findings were suggestive of hepatic adenoma.Birdem Med J 2015; 5(1) Supplement: 59-62

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The Malignant Transformation of Liver Cell Adenomas

Cited by 189 publications

References 17 publications

Malignant transformation of hepatic adenomas

Malignant transformation of hepatic adenomas

Management of liver adenomatosis: Results with a conservative surgical approach

Hepatic Adenoma - A Case Report

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