1
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Gatto A, Natale C, Preziosi A, Casanova M, Alaggio R, Cheli M, Macchini F, Zanini A. Congenital focal nodular hyperplasia-like lesion mimicking hepatoblastoma: anecdotal but plausible. WORLD JOURNAL OF PEDIATRIC SURGERY 2025; 8:e000980. [PMID: 40255645 PMCID: PMC12004462 DOI: 10.1136/wjps-2024-000980] [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: 12/11/2024] [Accepted: 02/16/2025] [Indexed: 04/22/2025] Open
Abstract
Focal nodular hyperplasia (FNH)-like lesions of the liver are rare in the pediatric population and are seldom reported as congenital lesions. The differential diagnosis between these lesions and pure-fetal hepatoblastoma (HBL) is challenging. We present a case of a congenital FNH-like hepatic lesion, managed with a right hepatectomy due to suspected fetal HBL. Additionally, a review of all published cases of congenital FNH-like lesions of the liver was carried out.MRI.
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Affiliation(s)
- Alessandra Gatto
- Department of Pediatric Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Chiara Natale
- Department of Pediatric Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandra Preziosi
- Department of Pediatric Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Rita Alaggio
- Pathology Department, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Italy
| | - Maurizio Cheli
- Department of Pediatric Surgery, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Francesco Macchini
- Department of Pediatric Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Zanini
- Department of Pediatric Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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2
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Paratore M, Garcovich M, Amodeo A, Fianchi F, Santopaolo F, Ponziani FR, Zocco MA, Gasbarrini A, Riccardi L, Pompili M. Evolution of focal nodular hyperplasia during long-term ultrasound follow-up: results from a single-center study. J Ultrasound 2025:10.1007/s40477-025-01010-1. [PMID: 40131690 DOI: 10.1007/s40477-025-01010-1] [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: 02/14/2025] [Accepted: 03/08/2025] [Indexed: 03/27/2025] Open
Abstract
PURPOSE To examine the natural history of focal nodular hyperplasia (FNH) lesions through long-term ultrasound (US) follow-up and assess the relationship between clinical characteristics and size changes. METHODS We retrospectively enrolled 55 patients diagnosed with FNH who were followed with ultrasound for at least 24 months. A total of 94 FNH nodules were included in the final analysis. A significant change in size was defined as an increase or decrease of 0.5 cm or more, and nodules were classified as increased, decreased or stable. Additionally, we analyzed the association between clinical data and changes in nodule size. RESULTS The mean follow-up duration between the initial US examination at diagnosis and the last available examination was 58.3 ± 33.5 months (range: 24.2-186.6). The majority of nodules remained stable (47.9%) or decreased in size (35.1%), while a small proportion of nodules disappeared (11.7%) and only 7.3% showed an increase in size. No significant association was found between size variation and factors such as oral contraceptive use, pregnancy, BMI or follow-up duration. CONCLUSION Changes in the size of FNHs during follow-up are relatively common, with most lesions remaining stable or undergoing regression or disappearance over time. These size variations do not appear to be influenced by hormonal factors or other clinical characteristics.
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Affiliation(s)
- Mattia Paratore
- Diagnostic and Interventional Ultrasound Unit, CEMAD Digestive Disease Center, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - Matteo Garcovich
- Diagnostic and Interventional Ultrasound Unit, CEMAD Digestive Disease Center, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy.
| | - Annamaria Amodeo
- Internal Medicine and Liver Transplantation Unit, Catholic University of Sacred Heart, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - Francesca Fianchi
- Internal Medicine and Gastroenterology Unit, CEMAD Digestive Disease Center, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - Francesco Santopaolo
- Internal Medicine and Gastroenterology Unit, CEMAD Digestive Disease Center, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - Francesca Romana Ponziani
- Internal Medicine and Gastroenterology Unit, CEMAD Digestive Disease Center, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
- Translational Medicine and Surgery Department, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Assunta Zocco
- Internal Medicine and Gastroenterology Unit, CEMAD Digestive Disease Center, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
- Translational Medicine and Surgery Department, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Gasbarrini
- Internal Medicine and Gastroenterology Unit, CEMAD Digestive Disease Center, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
- Translational Medicine and Surgery Department, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Riccardi
- Diagnostic and Interventional Ultrasound Unit, CEMAD Digestive Disease Center, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - Maurizio Pompili
- Internal Medicine and Liver Transplantation Unit, Catholic University of Sacred Heart, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
- Translational Medicine and Surgery Department, Università Cattolica del Sacro Cuore, Rome, Italy
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3
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Fukuda S, Hasegawa N, Mori K, Kawai H, Niisato Y, Endo M, Seo E, Sakamoto N, Matsubara D, Tsuchiya K. Shrinkage of Enlarged Hepatic Nodules by an Embolizing Congenital Extrahepatic Portosystemic Shunt. Intern Med 2024; 63:1237-1242. [PMID: 37690846 PMCID: PMC11116023 DOI: 10.2169/internalmedicine.2267-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/26/2023] [Indexed: 09/12/2023] Open
Abstract
A 38-year-old woman was admitted to our university hospital with loss of muscle strength. She was diagnosed with dermatomyositis and underwent contrast-enhanced computed tomography of the entire body to check for malignant tumors. Computed tomography revealed multiple enhanced hepatic nodules and an extrahepatic portosystemic shunt. Although a needle biopsy of the nodule could not diagnose definitive hepatocellular carcinoma, some nodules increased in size after three months. Because of the inconclusive results of the second biopsy, we performed shunt embolization using a vascular plug. After another three months, the hepatic nodules shrank markedly, as expected.
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Affiliation(s)
- Satoshi Fukuda
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Naoyuki Hasegawa
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Kensaku Mori
- Department of Radiology, Faculty of Medicine, University of Tsukuba, Japan
| | - Hitomi Kawai
- Department of Pathology, Faculty of Medicine, University of Tsukuba, Japan
| | - Yusuke Niisato
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Masato Endo
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Emiko Seo
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Noriaki Sakamoto
- Department of Pathology, Faculty of Medicine, University of Tsukuba, Japan
| | - Daisuke Matsubara
- Department of Pathology, Faculty of Medicine, University of Tsukuba, Japan
| | - Kiichiro Tsuchiya
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
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4
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Espinoza AF, Vasudevan SA, Masand PM, Lòpez-Terrada DH, Patel KR. Pediatric Hepatocellular Adenomas: What Is Known and What Is New? Cancers (Basel) 2023; 15:4790. [PMID: 37835484 PMCID: PMC10571754 DOI: 10.3390/cancers15194790] [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: 08/31/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Current understanding and classification of pediatric hepatocellular adenomas (HCA) are largely based on adult data. HCAs are rare in children and, unlike in adults, are often seen in the context of syndromes or abnormal background liver. Attempts to apply the adult classification to pediatric tumors have led to several "unclassifiable" lesions. Although typically considered benign, few can show atypical features and those with beta-catenin mutations have a risk for malignant transformation. Small lesions can be monitored while larger (>5.0 cm) lesions are excised due to symptoms or risk of bleeding/rupture, etc. Management depends on gender, age, underlying liver disease, multifocality, size of lesion, histologic subtype and presence of mutation, if any. In this review, we summarize the data on pediatric HCAs and highlight our experience with their diagnosis and management.
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Affiliation(s)
- Andres F. Espinoza
- Divisions of Pediatric Surgery and Surgical Research, Michael E. DeBakey Department of Surgery, Pediatric Surgical Oncology Laboratory, Texas Children’s Surgical Oncology Program, Texas Children’s Liver Tumor Program, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA; (A.F.E.); (S.A.V.)
| | - Sanjeev A. Vasudevan
- Divisions of Pediatric Surgery and Surgical Research, Michael E. DeBakey Department of Surgery, Pediatric Surgical Oncology Laboratory, Texas Children’s Surgical Oncology Program, Texas Children’s Liver Tumor Program, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA; (A.F.E.); (S.A.V.)
| | - Prakash M. Masand
- Department of Radiology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA;
| | - Dolores H. Lòpez-Terrada
- Department of Pathology and Immunology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA;
| | - Kalyani R. Patel
- Department of Pathology and Immunology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA;
- Abercrombie B1, Texas Children’s Hospital, Baylor College of Medicine, 6621 Fannin St., Houston, TX 77030, USA
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5
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Tsalikidis C, Mitsala A, Pappas-Gogos G, Romanidis K, Tsaroucha AK, Pitiakoudis M. Pedunculated Focal Nodular Hyperplasia: When in Doubt, Should We Cut It Out? J Clin Med 2023; 12:6034. [PMID: 37762973 PMCID: PMC10532121 DOI: 10.3390/jcm12186034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/10/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Focal nodular hyperplasia (FNH) is the second most common benign hepatic tumor and can rarely present as an exophytic solitary mass attached to the liver by a stalk. Most FNH cases are usually detected as incidental findings during surgery, imaging or physical examination and have a high female predominance. However, the pedunculated forms of FNH are particularly rare and commonly associated with severe complications and diagnostic challenges. Hence, our study aims to provide a comprehensive summary of the available data on the pedunculated FNH cases among adults and children. Furthermore, we will highlight the role of different therapeutic options in treating this clinical entity. The use of imaging techniques is considered a significant addition to the diagnostic toolbox. Regarding the optimal treatment strategy, the main indications for surgery were the presence of symptoms, diagnostic uncertainty and increased risk of complications, based on the current literature. Herein, we also propose a management algorithm for patients with suspected FNH lesions. Therefore, a high index of suspicion and awareness of this pathology and its life-threatening complications, as an uncommon etiology of acute abdomen, is of utmost importance in order to achieve better clinical outcomes.
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Affiliation(s)
- Christos Tsalikidis
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.); (G.P.-G.); (K.R.); (M.P.)
| | - Athanasia Mitsala
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.); (G.P.-G.); (K.R.); (M.P.)
| | - George Pappas-Gogos
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.); (G.P.-G.); (K.R.); (M.P.)
| | - Konstantinos Romanidis
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.); (G.P.-G.); (K.R.); (M.P.)
| | - Alexandra K. Tsaroucha
- Laboratory of Experimental Surgery & Surgical Research, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece
| | - Michail Pitiakoudis
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.); (G.P.-G.); (K.R.); (M.P.)
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6
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Zhang DL, Chen S, Lin YC, Ye W, Li K, Wu SS. Ultrasound-guided thermal ablation versus laparoscopic surgery for focal nodular hyperplasia of the liver: A retrospective controlled study. Front Oncol 2022; 12:932889. [PMID: 35992804 PMCID: PMC9386309 DOI: 10.3389/fonc.2022.932889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/06/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose This study aims to evaluate the value of the clinical application of ultrasound-guided percutaneous thermal ablation in focal nodular hyperplasia (FNH) by comparing its safety, effectiveness, and patient experience to surgery in the treatment of hepatic FNH ≤5 cm. Method This retrospective study enrolled 82 patients with hepatic FNH having a maximum diameter of ≤5 cm, confirmed by postoperative pathologic diagnosis or needle biopsy, who underwent thermal ablation or surgery between January 2019 and September 2021. Postoperative efficacy, surgical trauma (operation time, intraoperative bleeding volume, liver function, and lost volume of normal liver tissue), postoperative complications (postoperative infection, pleural effusion, and liver dysfunction), patient experience (degree and time of postoperative pain, postoperative fasting time, indwelling thoracic chest drain, and scar size), and economic indices (postoperative hospitalization and total charges) were compared between both groups. Result No significant difference existed in postoperative efficacy between both groups (p > 0.05). No recurrent or new lesions were observed during the 6-month follow-up in both groups. However, significant differences were observed in operation time, intraoperative bleeding volume, and lost volume of normal liver tissue (p < 0.05), with significantly less trauma in the thermal ablation group. No statistically significant differences in ALT, AST, and Hb existed between both groups (p > 0.05); however, albumin was higher in the ablation group compared to the surgery group (38.21 ± 3.32 vs. 34.84 ± 3.71 g/L, p < 0.05), and WBC were lower in the ablation group (11.91 ± 3.37 vs. 13.94 ± 3.65/L, p < 0.05). The incidence of postoperative complications in the ablation group was significantly lower than that in the surgery group (p < 0.05). Patient experiences were significantly better than in the surgical group (p < 0.05), with economic indicators being significantly less in the ablation group (p < 0.05). Conclusion Ultrasound-guided percutaneous thermal ablation can treat hepatic FNH ≤5 cm with similar clinical efficacy as surgery and is an economical, safe, and minimally invasive treatment method worthy of recommendation.
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Affiliation(s)
- Dan-ling Zhang
- Department of Ultrasonography, Fuzhou No.7 Hospital, Shengli Clinical College of Fujian Medical University, Fuzhou, China
| | - Sheng Chen
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical College of Fujian Medical University, Fuzhou, China
| | - Yu-cheng Lin
- Department of Ultrasonography, Affiliated Fuzhou First Hospital of Fujian Medical, Shengli Clinical College of Fujian Medical University, Fuzhou, China
| | - Wenxin Ye
- Department of Ultrasonography, Sanming Second Hospital, Shengli Clinical college of Fujian Medical University, Sanming, China
| | - Kai Li
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- *Correspondence: Song-song Wu, ; Kai Li,
| | - Song-song Wu
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical College of Fujian Medical University, Fuzhou, China
- *Correspondence: Song-song Wu, ; Kai Li,
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7
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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: 21] [Impact Index Per Article: 5.3] [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.
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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
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8
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Agnello F, Rabiolo L, Midiri F, Lo Re G, Grassedonio E, La Grutta L, Buscemi S, Agrusa A, Galia M. Focal hepatic intrinsically hyperattenuating lesions at unenhanced CT: Not always calcifications. Clin Imaging 2021; 80:304-314. [PMID: 34482241 DOI: 10.1016/j.clinimag.2021.08.020] [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: 05/20/2021] [Revised: 07/26/2021] [Accepted: 08/13/2021] [Indexed: 11/27/2022]
Abstract
Due to the growing use of CT, there has been an increase in the frequency of detecting focal liver lesions. Intrinsically hyperattenuating hepatic lesions or pseudolesions are not uncommon at unenhanced CT. Hyperattenuating hepatic lesions can be divided into non-calcified and calcified. Causes of intrinsic hyperattenuation include hemorrhage, thrombosis, and calcifications. Focal liver lesions can show hyperattenuation on unenhanced CT in case of severe liver steatosis. Recognition of etiologies associated with hyperattenuation on unenhanced CT can help the radiologist in characterizing focal liver lesions and pseudolesions. In this paper, we describe the spectrum of intrinsically hyperattenuating focal liver lesions and pseudolesions at unenhanced CT.
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Affiliation(s)
- Francesco Agnello
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Lidia Rabiolo
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Federico Midiri
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Giuseppe Lo Re
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Emanuele Grassedonio
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Ludovico La Grutta
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Salvatore Buscemi
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Antonino Agrusa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Massimo Galia
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy.
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Kim H, Park YN. Hepatocellular adenomas: recent updates. J Pathol Transl Med 2021; 55:171-180. [PMID: 33823565 PMCID: PMC8141970 DOI: 10.4132/jptm.2021.02.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/28/2021] [Indexed: 12/30/2022] Open
Abstract
Hepatocellular adenoma (HCA) is a heterogeneous entity, from both the histomorphological and molecular aspects, and the resultant subclassification has brought a strong translational impact for both pathologists and clinicians. In this review, we provide an overview of the recent updates on HCA from the pathologists’ perspective and discuss several practical issues and pitfalls that may be useful for diagnostic practice.
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Affiliation(s)
- Haeryoung Kim
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Nyun Park
- Department of Pathology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, Korea
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10
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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.
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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
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11
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Hepatocellular adenomas: review of pathological and molecular features. Hum Pathol 2020; 112:128-137. [PMID: 33307077 DOI: 10.1016/j.humpath.2020.11.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/16/2020] [Accepted: 11/30/2020] [Indexed: 12/18/2022]
Abstract
Hepatocellular adenoma (HCA) is a rare benign liver neoplasm which predominantly occurs in women in the reproductive age group taking oral contraception. Since 2002, the terminology HCA has defined an heterogeneous group of neoplastic benign hepatocellular proliferations composed of different subtypes. The genotype-phenotype classification led to the description of 5 well-recognized subtypes based on morphological and immunophenotypical features, that are currently used in practice: HNF1A inactivated HCA, inflammatory HCA, β-catenin mutated HCA, sonic hedgehog HCA, and unclassified HCA. The main complications observed in HCAs are bleeding and malignant transformation. Risk of malignant transformation into hepatocellular carcinoma (HCC), more frequent in men, is also dependent to tumor size and HCA subtype, reaching 40% in β-catenin mutated HCA. The distinction of HCA from well-differentiated HCC remains difficult in some cases, leading to the diagnosis of so-called "atypical/borderline HCA". The management of HCA is now based on multidisciplinary approach including clinicians, radiologists, and pathologists integrating gender, tumor size, and HCA subtyping.
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Abstract
Focal nodular hyperplasia and hepatocellular adenoma are benign liver lesions that occur most frequently in women and may be found as incidental findings on imaging. hepatocellular adenomas may be infrequently associated with malignant progression or risk of rupture and as such, require surveillance or definitive treatments based on their size threshold. It is important clinically to differentiate these lesions, and utilizing imaging modalities such as contrast enhanced ultrasound or magnetic resonance imaging can be helpful in diagnosis. Further molecular subtyping of hepatocellular adenoma lesions may be beneficial to describe risk factors and potential future clinical complications.
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Affiliation(s)
- Lauren Myers
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, MNP 4112, Portland, OR 97239, USA.
| | - Joseph Ahn
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, MNP 4112, Portland, OR 97239, USA
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13
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New MRI features improve subtype classification of hepatocellular adenoma. Eur Radiol 2018; 29:2436-2447. [PMID: 30523457 DOI: 10.1007/s00330-018-5784-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/31/2018] [Accepted: 09/20/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVE MRI is crucial for the classification of hepatocellular adenomas (HCA) into subtypes. Our objective was to review and increase MRI criteria for subtype classification and define the limits. METHODS Pathological and radiological data of 116 HCAs were retrospectively analyzed to investigate MRI features of HCA pathological subtypes. Risk for complication was also evaluated with regard to subtype and tumor size. RESULTS 38/43 (88%) HNF1α-mutated HCAs (H-HCAs) were discriminated by (i) fatty component (homogeneous or heterogeneous) and (ii) hypovascular pattern, with a sensitivity of 88% and a specificity of 97%. 51/58 (88%) inflammatory HCAs (IHCAs) displayed features of sinusoidal dilatation (SD) including three different patterns (global SD, atoll sign, and a new "crescent sign" corresponding to a partial peripheral rim, hyperintense on T2W and/or arterial phase with persistent delayed enhancement). Sensitivity was 88% and specificity 100%. However, some HCA remained unclassifiable by MRI: HCA remodeled by necrotic/hemorrhagic changes covering > 50% of the lesion, H-HCAs without steatosis, IHCAs without SD, β-catenin-mutated and unclassified HCAs. Regarding malignant transformation (5/116) and bleeding (24/116), none was observed when the HCA diameter was smaller than 5.2 cm and 4.2 cm, respectively. CONCLUSION Based on the largest series evaluated until now, we identified several non-described MRI features and propose new highly sensitive and specific MRI criteria. With the addition of these new features, 88% of the two main HCA subtypes could be identified. KEY POINTS • HNF1α-mutated hepatocellular adenomas (H-HCA) are characterized by the presence of fat and hypovascular pattern in MRI. • Inflammatory hepatocellular adenomas (I-HCA) are characterized by different patterns translating sinusoidal dilatation including the newly described crescent sign. • No MRI specific pattern was identified for β-catenin-mutated HCA (b-HCA).
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14
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Abstract
The differential diagnosis of hepatic mass lesions is broad and arriving at the right diagnosis can be challenging, especially on needle biopsies. The differential diagnosis of liver tumors in children is different from adults and is beyond the scope of this review. In adults, the approach varies depending on the age, gender, and presence of background liver disease. The lesions can be divided broadly into primary and metastatic (secondary), and the primary lesions can be further divided into those of hepatocellular origin and nonhepatocellular origin. The first category consists of benign and malignant lesions arising from hepatocytes, while the second category includes biliary, mesenchymal, hematopoietic, and vascular tumors. Discussion of nonepithelial neoplasms is beyond the scope of this review. The hepatocytic lesions comprise dysplastic nodules, focal nodular hyperplasia, hepatic adenoma, and hepatocellular carcinoma, and the differential diagnosis can be challenging requiring clinicopathological correlation and application of immunohistochemical (IHC) markers. Liver is a common site for metastasis, sometimes presenting with an unknown primary site, and proper workup is the key to arriving at the correct diagnosis. The correct diagnosis in this setting requires a systematic approach with attention to histologic features, imaging findings, clinical presentation, and judicious use of IHC markers. The list of antibodies that can be used for this purpose keeps on growing continually. It is important for pathologists to be up to date with the sensitivity and specificity of these markers and their diagnostic role and clinical implications. The purpose of this review is to outline the differential diagnosis of hepatic masses in adults and discuss an algorithmic approach to make a right diagnosis.
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Affiliation(s)
- Monika Vyas
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Dhanpat Jain
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
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15
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Collision of hepatocellular nodules in vascular livers: A medical challenge. Clin Res Hepatol Gastroenterol 2018; 42:e83-e85. [PMID: 30145279 DOI: 10.1016/j.clinre.2017.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/30/2017] [Accepted: 11/10/2017] [Indexed: 02/04/2023]
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16
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Abstract
Rapid advances in molecular and anatomic pathology have greatly improved our understanding of hepatocellular adenomas. Principle among them is a clinically relevant, histology-based classification that identifies hepatic adenomas at greatest risk for malignant transformation. This new classification system has led to general consensus on the major subtypes of hepatic adenomas. However, controversy remains regarding how to incorporate less common types of hepatic adenomas into the classification system and how to incorporate adenoma subtyping into clinical care. This article provides an in-depth review of how adenomas are classified, with a focus on the current rationale, the consensus, and controversies.
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Affiliation(s)
- Michael Torbenson
- Department of Laboratory Medicine and Pathology, 100 1st SE, Rochester, MN 55905, USA.
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17
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Copper deposition in focal nodular hyperplasia and inflammatory hepatocellular adenoma. J Clin Pathol 2017; 71:504-507. [DOI: 10.1136/jclinpath-2017-204820] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 10/27/2017] [Accepted: 10/30/2017] [Indexed: 11/03/2022]
Abstract
AimsTo examine copper deposition in focal nodular hyperplasia (FNH) and inflammatory hepatocellular adenoma (IHA) and to determine if it can play a role in their differentiation.Methods28 FNHs and 19 IHAs from surgical resections showing typical morphological and immunohistochemical features were stained with rhodanine to evaluate for copper deposition. Histological features such as nodularity, fibrous bands, ductular proliferation, steatosis, ballooned hepatocytes and lymphocytic inflammation were also scored.ResultsCopper deposition was detected in 96% (27/28) of FNHs and 37% (7/19) of IHAs, P<0.001. In all cases, copper was seen within the hepatocytes only around the pseudo-portal tracts or areas of fibrosis. Copper deposition in IHA was significantly associated with presence of lymphocytic inflammation (P=0.04) but not associated with features like nodularity, fibrous bands, ductular proliferation, ballooned hepatocytes and steatosis (P>0.05, for all). In FNH, the presence and degree of copper deposition was not significantly associated with any histological features (P>0.05, for all).ConclusionsCopper deposition occurs more frequently in FNH (96%) than IHA (37%), P<0.001. However, the presence of copper alone cannot be used as a feature to differentiate between FNH and IHA.
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18
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Nault JC, Paradis V, Cherqui D, Vilgrain V, Zucman-Rossi J. Molecular classification of hepatocellular adenoma in clinical practice. J Hepatol 2017; 67:1074-1083. [PMID: 28733222 DOI: 10.1016/j.jhep.2017.07.009] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/29/2017] [Accepted: 07/11/2017] [Indexed: 12/20/2022]
Abstract
Hepatocellular adenomas (HCA) are rare benign liver tumors occurring in young women taking contraception. They are associated with rare complications such as bleeding or malignant transformation into hepatocellular carcinoma. A molecular classification has divided HCA in several subgroups linked with risk factors, clinical behaviour, histological features and imaging: HNF1A inactivated HCA, Inflammatory HCA, CTNNB1 mutated HCA in exon 3, CTNNB1 mutated in exon 7 and 8 HCA, sonic hedgehog HCA and unclassified HCA. CTNNB1 mutated HCA in exon 3 and sonic hedgehog HCA have been linked with a high risk of malignant transformation and bleeding respectively. Herein, we review how molecular classification has modified our understanding of the pathophysiology and risk factors of HCA development, analysing its impact on clinical care in the field of diagnosis and therapeutic stratification.
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Affiliation(s)
- Jean-Charles Nault
- Unité Mixte de Recherche 1162, Génomique fonctionnelle des tumeurs solides, Institut National de la Santé et de la Recherche Médicale, Paris, France; Liver Unit, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France; Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France.
| | - Valérie Paradis
- Pathology Department, Beaujon Hospital, APHP, Clichy 92110, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM UMR 1149, Inflammation Research Center, Paris-Diderot University, Paris
| | - Daniel Cherqui
- Hepatobiliary Centre, Paul Brousse Hospital - Université Paris Sud, Institut National de la Santé et de la Recherche Médicale U1193, 14 Avenue Paul Vaillant Couturier, 94800 Villejuif, France
| | - Valérie Vilgrain
- University Paris Diderot, Sorbonne Paris Cité, Paris, France; Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3 Paris, France
| | - Jessica Zucman-Rossi
- Unité Mixte de Recherche 1162, Génomique fonctionnelle des tumeurs solides, Institut National de la Santé et de la Recherche Médicale, Paris, France; Université Paris Descartes, Labex Immuno-Oncology, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Assistance Publique-Hôpitaux de Paris, Hopital Europeen Georges Pompidou, F-75015 Paris, France
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Khemlina G, Ikeda S, Kurzrock R. The biology of Hepatocellular carcinoma: implications for genomic and immune therapies. Mol Cancer 2017; 16:149. [PMID: 28854942 PMCID: PMC5577674 DOI: 10.1186/s12943-017-0712-x] [Citation(s) in RCA: 310] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/15/2017] [Indexed: 02/08/2023] Open
Abstract
Hepatocellular carcinoma (HCC), the most common type of primary liver cancer, is a leading cause of cancer-related death worldwide. It is highly refractory to most systemic therapies. Recently, significant progress has been made in uncovering genomic alterations in HCC, including potentially targetable aberrations. The most common molecular anomalies in this malignancy are mutations in the TERT promoter, TP53, CTNNB1, AXIN1, ARID1A, CDKN2A and CCND1 genes. PTEN loss at the protein level is also frequent. Genomic portfolios stratify by risk factors as follows: (i) CTNNB1 with alcoholic cirrhosis; and (ii) TP53 with hepatitis B virus-induced cirrhosis. Activating mutations in CTNNB1 and inactivating mutations in AXIN1 both activate WNT signaling. Alterations in this pathway, as well as in TP53 and the cell cycle machinery, and in the PI3K/Akt/mTor axis (the latter activated in the presence of PTEN loss), as well as aberrant angiogenesis and epigenetic anomalies, appear to be major events in HCC. Many of these abnormalities may be pharmacologically tractable. Immunotherapy with checkpoint inhibitors is also emerging as an important treatment option. Indeed, 82% of patients express PD-L1 (immunohistochemistry) and response rates to anti-PD-1 treatment are about 19%, and include about 5% complete remissions as well as durable benefit in some patients. Biomarker-matched trials are still limited in this disease, and many of the genomic alterations in HCC remain challenging to target. Future studies may require combination regimens that include both immunotherapies and molecularly matched targeted treatments.
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Affiliation(s)
- Galina Khemlina
- Department of Geriatrics, University of California, UC San Diego, 9500 Gilman Drive, #9111, La Jolla, CA, 92093-9111, USA. .,Kaiser Permanente Southern California, San Diego, USA.
| | - Sadakatsu Ikeda
- Department of Medicine, Division of Hematology/Oncology, and Center for Personalized Cancer Therapy, University of California, Moores Cancer Center, San Diego, USA.,Tokyo Medical and Dental University, Tokyo, Japan
| | - Razelle Kurzrock
- Department of Medicine, Division of Hematology/Oncology, and Center for Personalized Cancer Therapy, University of California, Moores Cancer Center, San Diego, USA
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20
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Scali EP, Walshe T, Tiwari HA, Harris AC, Chang SD. A Pictorial Review of Hepatobiliary Magnetic Resonance Imaging With Hepatocyte-Specific Contrast Agents: Uses, Findings, and Pitfalls of Gadoxetate Disodium and Gadobenate Dimeglumine. Can Assoc Radiol J 2017; 68:293-307. [PMID: 28583364 DOI: 10.1016/j.carj.2016.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 09/21/2016] [Accepted: 10/25/2016] [Indexed: 12/20/2022] Open
Abstract
Magnetic resonance imaging (MRI) has a well-established role as a highly specific and accurate modality for characterizing benign and malignant focal liver lesions. In particular, contrast-enhanced MRI using hepatocyte-specific contrast agents (HSCAs) improves lesion detection and characterization compared to other imaging modalities and MRI techniques. In this pictorial review, the mechanism of action of gadolinium-based MRI contrast agents, with a focus on HSCAs, is described. The clinical indications, protocols, and emerging uses of the 2 commercially available combined contrast agents available in the United States, gadoxetate disodium and gadobenate dimeglumine, are discussed. The MRI features of these agents are compared with examples of focal hepatic masses, many of which have been obtained within the same patient therefore allowing direct lesion comparison. Finally, the pitfalls in the use of combined contrast agents in liver MRI are highlighted.
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Affiliation(s)
- Elena P Scali
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Triona Walshe
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hina Arif Tiwari
- Department of Radiology, University of Arizona, Tuscon, Arizona, USA
| | - Alison C Harris
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Silvia D Chang
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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21
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Larson BK, Guindi M. A Limited Immunohistochemical Panel Can Subtype Hepatocellular Adenomas for Routine Practice. Am J Clin Pathol 2017; 147:557-570. [PMID: 28472207 DOI: 10.1093/ajcp/aqx010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES β-Catenin-activated hepatocellular adenomas have an elevated risk of harboring foci of hepatocellular carcinoma. Inflammatory adenomas also have an increased propensity for malignant transformation and are associated with a systemic inflammatory syndrome. Patients with these two adenoma subtypes benefit from excision. We assessed whether β-catenin-activated and inflammatory adenomas could be identified using a limited immunohistochemical panel. METHODS Forty-six adenomas were assessed by morphology and β-catenin, serum amyloid A, and glutamine synthetase immunostains. RESULTS Morphologic examination produced a morphologic working diagnosis of inflammatory adenoma in 25 (54%) of 46 cases, β-catenin-activated adenoma in three (7%) of 46 cases, and 18 (39%) of 46 cases of other adenomas. After immunohistochemical staining, the morphologic diagnosis was confirmed in 15 (33%) of 46 and changed in 20 (43%) of 46, for a final distribution of 16 (35%) of 46 inflammatory adenomas, four (9%) of 46 β-catenin-activated adenomas, seven (15%) of 46 β-catenin-activated inflammatory adenomas, and 19 (41%) of 46 other adenomas. CONCLUSIONS Inflammatory and β-catenin-activated adenomas were readily identified by immunostaining patterns. These findings reinforce the necessity of immunohistochemistry in classifying adenomas, as assessing morphology alone often provided inaccurate subclassification. β-Catenin-activated and inflammatory adenomas can be accurately diagnosed using only a limited panel of widely available immunostains.
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MESH Headings
- Adenoma/classification
- Adenoma/metabolism
- Adenoma/pathology
- Adenoma, Liver Cell/classification
- Adenoma, Liver Cell/metabolism
- Adenoma, Liver Cell/pathology
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/metabolism
- Carcinoma, Hepatocellular/classification
- Carcinoma, Hepatocellular/metabolism
- Carcinoma, Hepatocellular/pathology
- Cell Transformation, Neoplastic
- Child
- Child, Preschool
- Female
- Glutamate-Ammonia Ligase/metabolism
- Humans
- Immunohistochemistry
- Liver Neoplasms/classification
- Liver Neoplasms/metabolism
- Liver Neoplasms/pathology
- Male
- Middle Aged
- Serum Amyloid A Protein
- Young Adult
- beta Catenin/metabolism
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Affiliation(s)
- Brent K Larson
- From the Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Maha Guindi
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
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22
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Bioulac-Sage P, Sempoux C, Balabaud C. Hepatocellular Adenomas: Morphology and Genomics. Gastroenterol Clin North Am 2017; 46:253-272. [PMID: 28506364 DOI: 10.1016/j.gtc.2017.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Hepatocellular adenomas (HCAs) are rare benign tumors. This single entity has been split into 3 subtypes corresponding to specific mutations: HNF1α-inactivated HCA; inflammatory HCA related to different mutations, all leading to activation of STAT3 pathway; and β-catenin-activated HCA related to CTNNB1 mutations. The risk of malignant transformation depends on the level of β-catenin activation, reported mainly for exon 3, including S45. It is possible using specific immunohistochemical markers to identify the 3 different HCA subtypes and the level of β-catenin activation. Fewer than 10% of HCAs remain unclassified.
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Affiliation(s)
| | - Christine Sempoux
- Service of Clinical Pathology, Lausanne University Hospital, Institute of Pathology, Rue du Bugnon 25, CH-1011 Lausanne, Switzerland
| | - Charles Balabaud
- Inserm U 1053, Université Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux, France
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23
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Nault JC, Couchy G, Balabaud C, Morcrette G, Caruso S, Blanc JF, Bacq Y, Calderaro J, Paradis V, Ramos J, Scoazec JY, Gnemmi V, Sturm N, Guettier C, Fabre M, Savier E, Chiche L, Labrune P, Selves J, Wendum D, Pilati C, Laurent A, De Muret A, Le Bail B, Rebouissou S, Imbeaud S, Bioulac-Sage P, Letouzé E, Zucman-Rossi J. Molecular Classification of Hepatocellular Adenoma Associates With Risk Factors, Bleeding, and Malignant Transformation. Gastroenterology 2017; 152:880-894.e6. [PMID: 27939373 DOI: 10.1053/j.gastro.2016.11.042] [Citation(s) in RCA: 268] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 11/17/2016] [Accepted: 11/21/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Hepatocellular adenomas (HCAs) are benign liver tumors that can be assigned to molecular subtypes based on inactivating mutations in hepatocyte nuclear factor 1A, activating mutations in β-catenin, or activation of inflammatory signaling pathways. We aimed to update the classification system for HCA and associate the subtypes with disease risk factors and complications. METHODS We analyzed expression levels of 20 genes and sequenced exon regions of 8 genes (HNF1A, IL6ST, CTNNB1, FRK, STAT3, GNAS, JAK1, and TERT) in 607 samples of 533 HCAs from 411 patients, collected from 28 centers mainly in France from 2000 and 2014. We performed gene expression profile, RNA sequence, whole-exome and genome sequence, and immunohistochemical analyses of select samples. Molecular data were associated with risk factors, histopathology, bleeding, and malignant transformation. RESULTS Symptomatic bleeding occurred in 14% of the patients (85% of cases were female, median age, 38 years); 7% of the nodules were borderline between HCA and hepatocellular carcinoma, and 3% of patients developed hepatocellular carcinoma from HCA. Based on molecular features, we classified HCA into 8 subgroups. One new subgroup, composed of previously unclassified HCA, represented 4% of HCAs overall and was associated with obesity and bleeding. These tumors were characterized by activation of sonic hedgehog signaling, due to focal deletions that fuse the promoter of INHBE with GLI1. Analysis of genetic heterogeneity among multiple HCAs, from different patients, revealed a molecular subtype field effect; multiple tumors had different mutations that deregulated similar pathways. Specific molecular subtypes of HCA associated with various HCA risk factors, including imbalances in estrogen or androgen hormones. Specific molecular subgroup of HCA with β-catenin and sonic hedgehog activation associated with malignant transformation and bleeding, respectively. CONCLUSIONS Using sequencing and gene expression analyses, we identified a subgroup of HCA characterized by fusion of the INHBE and GLI1 genes and activation of sonic hedgehog pathway. Molecular subtypes of HCAs associated with different patients' risk factors for HCA, disease progression, and pathology features of tumors. This classification system might be used to select treatment strategies for patients with HCA.
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Affiliation(s)
- Jean-Charles Nault
- Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Université Paris Descartes, Université Paris Diderot, Paris, France; Liver Unit, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bondy, France; Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France
| | - Gabrielle Couchy
- Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Université Paris Descartes, Université Paris Diderot, Paris, France
| | - Charles Balabaud
- Université Bordeaux, Bordeaux Research in Translational Oncology, Bordeaux, France
| | - Guillaume Morcrette
- Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Université Paris Descartes, Université Paris Diderot, Paris, France
| | - Stefano Caruso
- Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Université Paris Descartes, Université Paris Diderot, Paris, France
| | - Jean-Frederic Blanc
- Université Bordeaux, Bordeaux Research in Translational Oncology, Bordeaux, France; Service Hépato-Gastroentérologie et Oncologie Digestive, Centre Medico-Chirurgical Magellan, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Yannick Bacq
- Service d'Hépatogastroentérologie, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Julien Calderaro
- Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Université Paris Descartes, Université Paris Diderot, Paris, France; Service d'Anatomopathologie, Hôpital Henri Mondor, Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - Valérie Paradis
- Service d'Anatomopathologie, Hôpital Beaujon, Clichy, France
| | - Jeanne Ramos
- Service d'Anatomopathologie, Gui de Chauliac, Montpellier, France
| | - Jean-Yves Scoazec
- Service d'Anatomopathologie, Institut Gustave Roussy, Villejuif, France
| | - Viviane Gnemmi
- Institut de Pathologie, Centre Hospitalier Régional Universitaire de Lille, UMR-S 1124, Jean-Pierre Aubert Research Center, Lille, France
| | - Nathalie Sturm
- Service d'Anatomopathologie, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Catherine Guettier
- Service d'Anatomopathologie, Hôpitaux Paul Brousse et Bicêtre, Le Kremlin Bicêtre, Institut National de la Santé et de la Recherche Médicale U1193 Université Paris-Sud, Orsay, France
| | - Monique Fabre
- Service d'Anatomopathologie, Hôptal Necker-Enfants Malades, Paris, France
| | - Eric Savier
- Service de Chirurgie Hépato-Bilio-Pancréatique, Centre Hospitalier Universitaire, Pitié Salpétrière, Université Pierre et Marie Curie, Paris, France
| | - Laurence Chiche
- Service de Chirurgie Digestive, Centre Medico-Chirurgical Magellan, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | - Philippe Labrune
- Assistance Hôpitaux Publique de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital Antoine Béclère, Centre de Référence des Maladies Héréditaires du Métabolisme Hépatique, Clamart, and Université Paris-Sud, and Institut National de la Santé et de la Recherche Médicale U 1169, Orsay, France
| | - Janick Selves
- Département d'Anatomopathologie, Institut Universitaire du Cancer-Oncopole, Toulouse, France
| | - Dominique Wendum
- Service d'Anatomie Pathologique, Assistance Hôpitaux Publique de Paris Hôpital St Antoine, Sorbonne Universités, Université Pierre et Marie Curie 06, Paris, France
| | - Camilla Pilati
- Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Université Paris Descartes, Université Paris Diderot, Paris, France
| | - Alexis Laurent
- Service de Chirurgie Digestive, Hôpital Henri Mondor, Créteil, Institut National de la Santé et de la Recherche Médicale U955, Créteil, France
| | - Anne De Muret
- Service d'anatomopathologie, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Brigitte Le Bail
- Université Bordeaux, Bordeaux Research in Translational Oncology, Bordeaux, France; Service de Pathologie, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Sandra Rebouissou
- Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Université Paris Descartes, Université Paris Diderot, Paris, France
| | - Sandrine Imbeaud
- Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Université Paris Descartes, Université Paris Diderot, Paris, France
| | | | - Paulette Bioulac-Sage
- Université Bordeaux, Bordeaux Research in Translational Oncology, Bordeaux, France; Service de Pathologie, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Eric Letouzé
- Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Université Paris Descartes, Université Paris Diderot, Paris, France
| | - Jessica Zucman-Rossi
- Unité Mixte de Recherche 1162, Génomique Fonctionnelle des Tumeurs Solides, Institut National de la Santé et de la Recherche Médicale, Université Paris Descartes, Université Paris Diderot, Paris, France; Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Département d'Oncologie, Paris, France.
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Yoneda N, Matsui O, Kitao A, Kozaka K, Kobayashi S, Sasaki M, Yoshida K, Inoue D, Minami T, Gabata T. Benign Hepatocellular Nodules: Hepatobiliary Phase of Gadoxetic Acid-enhanced MR Imaging Based on Molecular Background. Radiographics 2016; 36:2010-2027. [PMID: 27740898 DOI: 10.1148/rg.2016160037] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Gadoxetic acid is a contrast agent for magnetic resonance (MR) imaging with hepatocyte-specific properties and is becoming increasingly important in detection and characterization of hepatocellular carcinoma and benign hepatocellular nodules, including focal nodular hyperplasia (FNH), nodular regenerative hyperplasia (NRH), hepatocellular adenoma (HCA), and dysplastic nodule. In these hepatocellular nodules, a positive correlation between the grade of membranous uptake transporter organic anion-transporting polypeptide (OATP) 1B3 expression and signal intensity in the hepatobiliary (HB) phase has been verified. In addition, it has been clarified that OATP1B3 expression is regulated by activation of β-catenin and/or hepatocyte nuclear factor 4α. On the other hand, recent studies have also revealed some of the background molecular mechanisms of benign hepatocellular nodules. FNH commonly shows iso- or hyperintensity in the HB phase with equal or stronger OATP1B3 expression, with map-like distribution of glutamine synthetase (a target of Wnt/β-catenin signaling) and OATP1B3 expression. NRH shows doughnut-like enhancement with hypointensity in the central portion in the HB phase with OATP1B3 expression. The majority of HCAs show hypointensity in the HB phase, but β-catenin-activated HCA exclusively demonstrates iso- or hyperintensity with increased expression of nuclear β-catenin, glutamine synthetase, and OATP1B3. Dysplastic nodule commonly shows iso- or hyperintensity in the HB phase with similar to increased OATP1B3 expression, but one-third of high-grade dysplastic nodules can be demonstrated as a hypointense nodule with decreased OATP1B3 expression. Knowledge of these background molecular mechanisms of gadoxetic acid-enhanced MR imaging is important not only for precise imaging diagnosis but also understanding of the pathogenesis of benign hepatocellular nodules. ©RSNA, 2016.
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Affiliation(s)
- Norihide Yoneda
- From the Departments of Radiology (N.Y., O.M., A.K., K.K., K.Y., D.I., T.M., T.G.), Quantum Medical Imaging (S.K.), and Human Pathology (M.S.), Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8640, Japan
| | - Osamu Matsui
- From the Departments of Radiology (N.Y., O.M., A.K., K.K., K.Y., D.I., T.M., T.G.), Quantum Medical Imaging (S.K.), and Human Pathology (M.S.), Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8640, Japan
| | - Azusa Kitao
- From the Departments of Radiology (N.Y., O.M., A.K., K.K., K.Y., D.I., T.M., T.G.), Quantum Medical Imaging (S.K.), and Human Pathology (M.S.), Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8640, Japan
| | - Kazuto Kozaka
- From the Departments of Radiology (N.Y., O.M., A.K., K.K., K.Y., D.I., T.M., T.G.), Quantum Medical Imaging (S.K.), and Human Pathology (M.S.), Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8640, Japan
| | - Satoshi Kobayashi
- From the Departments of Radiology (N.Y., O.M., A.K., K.K., K.Y., D.I., T.M., T.G.), Quantum Medical Imaging (S.K.), and Human Pathology (M.S.), Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8640, Japan
| | - Motoko Sasaki
- From the Departments of Radiology (N.Y., O.M., A.K., K.K., K.Y., D.I., T.M., T.G.), Quantum Medical Imaging (S.K.), and Human Pathology (M.S.), Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8640, Japan
| | - Kotaro Yoshida
- From the Departments of Radiology (N.Y., O.M., A.K., K.K., K.Y., D.I., T.M., T.G.), Quantum Medical Imaging (S.K.), and Human Pathology (M.S.), Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8640, Japan
| | - Dai Inoue
- From the Departments of Radiology (N.Y., O.M., A.K., K.K., K.Y., D.I., T.M., T.G.), Quantum Medical Imaging (S.K.), and Human Pathology (M.S.), Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8640, Japan
| | - Tetsuya Minami
- From the Departments of Radiology (N.Y., O.M., A.K., K.K., K.Y., D.I., T.M., T.G.), Quantum Medical Imaging (S.K.), and Human Pathology (M.S.), Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8640, Japan
| | - Toshifumi Gabata
- From the Departments of Radiology (N.Y., O.M., A.K., K.K., K.Y., D.I., T.M., T.G.), Quantum Medical Imaging (S.K.), and Human Pathology (M.S.), Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8640, Japan
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Roncalli M, Sciarra A, Tommaso LD. Benign hepatocellular nodules of healthy liver: focal nodular hyperplasia and hepatocellular adenoma. Clin Mol Hepatol 2016; 22:199-211. [PMID: 27189732 PMCID: PMC4946404 DOI: 10.3350/cmh.2016.0101] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 04/01/2016] [Indexed: 02/06/2023] Open
Abstract
Owing to the progress of imaging techniques, benign hepatocellular nodules are increasingly discovered in the clinical practice. This group of lesions mostly arises in the context of a putatively normal healthy liver and includes either pseudotumoral and tumoral nodules. Focal nodular hyperplasia and hepatocellular adenoma are prototypical examples of these two categories of nodules. In this review we aim to report the main pathological criteria of differential diagnosis between focal nodular hyperplasia and hepatocellular adenoma, which mainly rests upon morphological and phenotypical features. We also emphasize that for a correct diagnosis the clinical context such as sex, age, assumption of oral contraceptives, associated metabolic or vascular disturbances is of paramount importance. While focal nodular hyperplasia is a single entity epidemiologically more frequent than adenoma, the latter is representative of a more heterogeneous group which has been recently and extensively characterized from a clinical, morphological, phenotypical and molecular profile. The use of the liver biopsy in addition to imaging and the clinical context are important diagnostic tools of these lesions. In this review we will survey their systematic pathobiology and propose a diagnostic algorithm helpful to increase the diagnostic accuracy of not dedicated liver pathologists. The differential diagnosis between so-called typical and atypical adenoma and well differentiated hepatocellular carcinoma will also be discussed.
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Affiliation(s)
- Massimo Roncalli
- Pathology Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Amedeo Sciarra
- Pathology Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.,University of Milan School of Medicine, Milan, Italy
| | - Luca Di Tommaso
- Pathology Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
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Strauss E, Ferreira ADSP, França AVC, Lyra AC, Barros FMDR, Silva I, Garcia JHP, Parise ER. Diagnosis and treatment of benign liver nodules: Brazilian Society of Hepatology (SBH) recommendations. ARQUIVOS DE GASTROENTEROLOGIA 2015; 52 Suppl 1:47-54. [PMID: 26959805 DOI: 10.1590/s0004-28032015000500003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Space-occupying lesions of the liver may be cystic or solid. Ultrasonography is an extremely useful method for initial screening, and suffices for diagnosis of simple hepatic cysts. Complex cysts and solid masses require computed tomography or magnetic resonance imaging for confirmation. Wide surgical excision is indicated in cystadenoma or cystadenocarcinoma. Clinical and epidemiological data are important, as nodules in noncirrhotic livers are more likely to be benign. Hemangiomas, the most common benign tumors, require no follow-up after diagnostic confirmation if they are small and asymptomatic. Patients with giant, symptomatic hemangiomas or compression of adjacent structures should be referred to hepatobiliary centers for potential surgery. The genetic heterogeneity of hepatocellular adenomas and their epidemiology and prognosis prompted classification of these tumors into four subtypes based on histology and immunohistochemistry. The major complications of hepatocellular adenomas are rupture with bleeding and malignant transformation. Rupture occurs in approximately 30% of cases. The main risk factors are tumors size >5 cm and inflammatory subtype. Hepatocellular adenomas may enlarge during pregnancy due to marked hormonal stimulation. As oral contraceptive pills and anabolic steroids have associated with hepatocellular adenomas growth, particularly of the hepatocyte nuclear factor-1alfa subtype, these drugs should be discontinued. Focal nodular hyperplasia is the second most common benign tumor of the liver. It is most frequent in women aged 20 to 60, and 70% to 90% of cases are asymptomatic. In the absence of a central scar and/or other hallmarks of Focal nodular hyperplasia, with uncertainty between this diagnosis and hepatocellular adenoma, liver-specific contrast agents are indicated.
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Affiliation(s)
- Edna Strauss
- Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
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Shih A, Lauwers GY, Balabaud C, Bioulac-Sage P, Misdraji J. Simultaneous occurrence of focal nodular hyperplasia and HNF1A-inactivated hepatocellular adenoma: a collision tumor simulating a composite FNH-HCA. Am J Surg Pathol 2015; 39:1296-300. [PMID: 26274031 DOI: 10.1097/pas.0000000000000477] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Mixed focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) within a single tumor mass is rarely reported, and most of these cases are examples of tumors with features intermediate between FNH and HCA. Although a few reported cases are probably examples of true mixed tumors, none was evaluated immunohistochemically or confirmed by molecular analysis. We report a mixed FNH and HCA arising in a woman with several HNF1A-inactivated adenomas. Our case is the first case of mixed FNH and HNF1A-inactivated HCA documented by immunohistochemistry.
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Affiliation(s)
- Angela Shih
- *James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Harvard Medical School, Boston, MA †Inserm U1053, Université de Bordeaux ‡Pathology Department, Pellegrin Hospital, CHU Bordeaux, Bordeaux, France
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Thomeer MG, E Bröker ME, de Lussanet Q, Biermann K, Dwarkasing RS, de Man R, Ijzermans JN, de Vries M. Genotype-phenotype correlations in hepatocellular adenoma: an update of MRI findings. Diagn Interv Radiol 2015; 20:193-9. [PMID: 24509184 DOI: 10.5152/dir.2013.13315] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hepatocellular adenoma (HCA) is a generally benign liver tumor with the potential for malignancy and bleeding. HCAs are categorized into four subtypes on the basis of genetic and pathological features: hepatocyte nuclear factor 1α-mutated HCA, β-catenin-mutated HCA, inflammatory HCA, and unclassified HCA. Magnetic resonance imaging (MRI) plays an important role in the diagnosis, subtype characterization, and detection of HCA complications; it is also used to differentiate HCA from focal nodular hyperplasia. In this review, we present an overview of the genetic abnormalities, oncogenesis, and typical and atypical MRI findings of specific subtypes of HCA using contrast-enhanced MRI with or without hepatobiliary contrast agents (gadobenate dimeglumine and gadoxetate disodium). We also discuss their different management implications after diagnosis.
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Affiliation(s)
- Maarten G Thomeer
- From the Departments of Radiology Medical Center Zuiderzee, Lelystad, the Netherlands.
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30
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Swanson BJ, Yearsley MM, Marsh W, Frankel WL. A triple stain of reticulin, glypican-3, and glutamine synthetase: a useful aid in the diagnosis of liver lesions. Arch Pathol Lab Med 2015; 139:537-42. [PMID: 25822763 DOI: 10.5858/arpa.2013-0645-oa] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The correct histologic diagnosis of mass lesions of the liver can be difficult, especially in biopsy samples. Reticulin, glypican-3, and glutamine synthetae are stains that can help distinguish hepatocellular carcinoma, hepatic adenoma, and focal nodular hyperplasia. OBJECTIVE To evaluate the utility of a triple stain of reticulin, glypican-3, and glutamine synthetae in distinguishing hepatocellular carcinoma, hepatic adenoma, and focal nodular hyperplasia. DESIGN Whole tissue sections and tissue microarrays were evaluated with a triple stain of reticulin, followed by glutamine synthetae (diaminobenzidine, brown chromogen) and glypican-3 (alkaline phosphatase, red chromogen). The 109 cases evaluated included whole tissue section hepatocellular carcinoma (n = 16), tissue microarray hepatocellular carcinoma (n = 19), whole tissue section hepatic adenoma (n = 15), tissue microarray hepatic adenoma (n = 13), whole tissue section focal nodular hyperplasia (n = 13; 12%), tissue microarray focal nodular hyperplasia (n = 13), as well as nonmalignant liver parenchyma adjacent to hepatocellular carcinoma (n = 20). All cases were scored for reticulin being intact or lost, positive or negative staining for glypican-3, and diffuse, maplike, perivenular, or negative staining for glutamine synthetae. RESULTS The combination of intact reticulin with either glypican-3 negativity or negative glutamine synthetae was 92% sensitive and 95% specific in the distinction of tissue microarray hepatic adenoma from hepatocellular carcinoma. For the distinction of tissue microarray focal nodular hyperplasia and hepatic adenoma, maplike glutamine synthetae was most useful and was 85% sensitive and 100% specific. CONCLUSIONS The triple stain of reticulin, glypican-3, and glutamine synthetae is useful in the differentiation of hepatocellular carcinoma, hepatic adenoma, and focal nodular hyperplasia on biopsy specimens. Furthermore, this triple stain is advantageous to single stains and can help when aberrant staining patterns are observed.
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Affiliation(s)
- Benjamin J Swanson
- From the Department of Pathology, Ohio State University Wexner Medical Center, Columbus
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McInnes MDF, Hibbert RM, Inácio JR, Schieda N. Focal Nodular Hyperplasia and Hepatocellular Adenoma: Accuracy of Gadoxetic Acid-enhanced MR Imaging--A Systematic Review. Radiology 2015; 277:413-23. [PMID: 26020440 DOI: 10.1148/radiol.2015142986] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To perform a systematic review to evaluate the diagnostic accuracy of hepatobiliary (HPB) phase gadoxetic acid-enhanced MR imaging of the liver in the diagnosis of focal nodular hyperplasia (FNH) versus hepatocellular adenoma (HCA) and to identify the rate of (a) reported HCAs that are iso- or hyperintense to liver and (b) reported FNHs that are hypointense to liver on HPB phase MR images. MATERIALS AND METHODS The institutional review board granted a waiver for this study type, and multiple databases were searched for studies in which researchers distinguished between FNH and HCA with gadoxetic acid-enhanced MR imaging. Studies to evaluate diagnostic accuracy were included; case reports and series were included to analyze the rate of iso- or hyperintense HCAs on HPB phase MR images. Risk of bias was assessed by using the Quality Assessment Tool for Diagnostic Accuracy Studies-2. Sensitivity and specificity were plotted with a forest plot; pooling was not performed because a small number of heterogeneous studies were included. Rate of iso- or hyperintense HCA on HPB phase gadoxetic acid-enhanced MR images was evaluated. RESULTS Six studies (309 patients; 164 with HCA, 233 with FNH) were included for diagnostic accuracy assessment. Twelve case series (129 patients; 81 with HCA, 70 with FNH) were included (studies with insufficient 2 × 2 table data for diagnostic accuracy assessment). Sensitivity was high (range, 0.91-1.00; lower margin of the 95% confidence interval: 0.77). Specificity was high (range, 0.87-1.00; lower margin of the 95% confidence interval: 0.54). Specificity was lowest among studies in which molecular subtyping of HCA was performed. Rate of iso-or hyperintensity of HCA on HPB phase MR images was variable (range, 0%-67%) and occurred more frequently in the inflammatory subtype. High risk of bias was identified in the domains of patient selection and reference standard. CONCLUSION The reported diagnostic accuracy of HPB phase gadoxetic acid-enhanced MR imaging in the diagnosis of HCA versus FNH is high; however, studies are few, heterogeneous, and at high risk for bias, indicating that diagnostic accuracy may be overestimated.
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Affiliation(s)
- Matthew D F McInnes
- From the Department of Radiology, Clinical Epidemiology Program, University of Ottawa, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa Hospital Civic Campus, Room c159, Ottawa ON, Canada K1Y 4E9
| | - Rebecca M Hibbert
- From the Department of Radiology, Clinical Epidemiology Program, University of Ottawa, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa Hospital Civic Campus, Room c159, Ottawa ON, Canada K1Y 4E9
| | - João R Inácio
- From the Department of Radiology, Clinical Epidemiology Program, University of Ottawa, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa Hospital Civic Campus, Room c159, Ottawa ON, Canada K1Y 4E9
| | - Nicola Schieda
- From the Department of Radiology, Clinical Epidemiology Program, University of Ottawa, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa Hospital Civic Campus, Room c159, Ottawa ON, Canada K1Y 4E9
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Blanc JF, Frulio N, Chiche L, Bioulac-Sage P, Balabaud C. Hepatocellular adenoma management: advances but still a long way to go. Hepat Oncol 2015; 2:171-180. [PMID: 30190996 DOI: 10.2217/hep.14.41] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hepatocellular adenomas (HCAs) are composed of four molecular subgroups: mutations inactivating the HNF1A gene; the inflammatory phenotype with mutations of different genes leading to STAT3 activation; the activation of β-catenin by mutations in exon 3; among β-HCA, half display both inflammatory and β-catenin-activated phenotypes; and the unclassified tumors. The identification of these subtypes by MRI and immunohistochemistry on tissue is considered as a major criterion to manage patients. Of particular relevance is the identification of the β-catenin-mutated group due to its high risk of malignant transformation. In spite of this progress, the classification has not gained recognition among surgeons. It is hoped that by working as a multidisciplinary team, including surgeons, radiologists, pathologists and molecular biologists, patients will be managed more rationally. In this article, we will present known and new data, well accepted and that which is still controversial. The progress made in the field of HCA in the last 12 years, whether in epidemiology, diagnosis (clinical, pathology, imaging) or management, is related in one way or another to molecular advances.
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Affiliation(s)
- Jean Frédéric Blanc
- Hepato-gastroenterology & Digestive Oncology Unit, CHU Bordeaux, Saint-André Hospital, 1 rue Jean Burguet 33075 Bordeaux, France.,Hepato-gastroenterology & Digestive Oncology Unit, CHU Bordeaux, Saint-André Hospital, 1 rue Jean Burguet 33075 Bordeaux, France
| | - Nora Frulio
- Department of Diagnostic & Interventional Imaging, CHU Bordeaux, Saint André hospital, 1 rue Jean Burguet 33075 Bordeaux, France.,Department of Diagnostic & Interventional Imaging, CHU Bordeaux, Saint André hospital, 1 rue Jean Burguet 33075 Bordeaux, France
| | - Laurence Chiche
- Department of Digestive Surgery, Haut Lévêque Hospital, CHU Bordeaux, Avenue de Magellan 33604 PESSAC cedex, France.,Department of Digestive Surgery, Haut Lévêque Hospital, CHU Bordeaux, Avenue de Magellan 33604 PESSAC cedex, France
| | - Paulette Bioulac-Sage
- Department of Pathology, Pellegrin Hospital, CHU Bordeaux, 33076 Bordeaux, France.,Inserm, UMR-1053, Université de Bordeaux, 33076 Bordeaux, France.,Department of Pathology, Pellegrin Hospital, CHU Bordeaux, 33076 Bordeaux, France.,Inserm, UMR-1053, Université de Bordeaux, 33076 Bordeaux, France
| | - Charles Balabaud
- Inserm, UMR-1053, Université de Bordeaux, 33076 Bordeaux, France.,Inserm, UMR-1053, Université de Bordeaux, 33076 Bordeaux, France
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33
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Marti J, Trivedi A, D'Alessandro V, Roayaie S, Rosen A, Arnon R, Thung S. Calcified telangiectatic hyperplastic nodule associated with vascular malformation in a child: a case report. Fetal Pediatr Pathol 2015; 34:108-16. [PMID: 25353700 DOI: 10.3109/15513815.2014.970264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This is a case report of an asymptomatic 4-year-old girl who was found to have a nodule at the lateral left lobe of the liver. She underwent transabdominal liver ultrasound and abdominal MRI that showed calcification and intense arterial enhancement but they failed to clearly exclude malignancy. The patient underwent an unremarkable laparoscopic wedge liver resection of the lesion because of its location and size. Pathological examination showed features compatible with a benign telangiectatic hyperplastic nodule with vascular malformation and calcification. CD34 immunostained the proliferative vascular lining cells while CK7 and CK19 highlighted the normal bile ducts present within the lesion. The diagnosis of a telangiectatic hyperplastic nodule associated with vascular malformation has been scarcely reported in children and our case shows for the first time that it can also present with calcifications.
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Affiliation(s)
- Josep Marti
- 1Mount Sinai Medical Center, Recanati-Miller Transplant Institute , New York, NY , USA
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Current updates on the molecular genetics and magnetic resonance imaging of focal nodular hyperplasia and hepatocellular adenoma. Insights Imaging 2015; 6:347-62. [PMID: 25790815 PMCID: PMC4444792 DOI: 10.1007/s13244-015-0399-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/29/2015] [Accepted: 02/04/2015] [Indexed: 12/19/2022] Open
Abstract
UNLABELLED Focal nodular hyperplasia (FNH) and hepatocellular adenomas (HCAs) constitute benign hepatic neoplasms in adults. HCAs are monoclonal neoplasms characterised by an increased predilection to haemorrhage and also malignant transformation. On the other hand, FNH is a polyclonal tumour-like lesion that occurs in response to increased perfusion and has an uneventful clinical course. Recent advances in molecular genetics and genotype-phenotype correlation in these hepatocellular neoplasms have enabled a new classification system. FNHs are classified into the typical and atypical types based on histomorphological and imaging features. HCAs have been categorised into four subtypes: (1) HCAs with HNF-1α mutations are diffusely steatotic, do not undergo malignant transformation, and are associated with familial diabetes or adenomatosis. (2) Inflammatory HCAs are hypervascular with marked peliosis and a tendency to bleed. They are associated with obesity, alcohol and hepatic steatosis. (3) HCAs with β-catenin mutations are associated with male hormone administration and glycogen storage disease, frequently undergo malignant transformation and may simulate hepatocellular carcinoma on imaging. (4) The final type is unclassified HCAs. Each of these except the unclassified subtype has a few distinct imaging features, often enabling reasonably accurate diagnosis. Biopsy with immunohistochemical analysis is helpful in difficult cases and has strong implications for patient management. TEACHING POINTS • FNHs are benign polyclonal neoplasms with no risk of haemorrhage or malignancy. • HCAs are benign monoclonal neoplasms classified into four subtypes based on immunohistochemistry. • Inflammatory HCAs show an atoll sign with a risk of bleeding and malignant transformation. • HNF-1α HCAs are steatotic HCAs with minimal complications and the best prognosis. • β-Catenin HCA shows variable MRI features and a high risk of malignancy.
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Pinotti E, Ratti F, Cipriani F, Paganelli M, Catena M, Finazzi R, Aldrighetti L. Focal Nodular Hyperplasia. BENIGN TUMORS OF THE LIVER 2015:159-168. [DOI: 10.1007/978-3-319-12985-3_12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Abstract
Hepatocellular adenomas (HCA) are rare, benign liver tumours that often occur in women of reproductive age. HCA has been associated with the use of oral contraceptives, but the increased incidence of the tumour in older women and in men has linked the tumour type to other diseases, including the metabolic syndrome. Genotypical classification of the adenomas has led to the identification of four subgroups that correlate genotype with phenotype: human hepatocyte nuclear factor-1 alpha (HNF1α) inactivating HCA, β-catenin activating HCA, inflammatory HCA and unclassified HCA. HNF1α inactivating HCA is associated with bi-allelic mutations in the TCF1 gene and morphologically has marked steatosis. β-catenin activating HCA has increased activity of the Wnt/β-catenin pathway and is associated with possible malignant transformation. Inflammatory HCA is characterized by an oncogene-induced inflammation due to alterations in the Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway. In the diagnostic setting, sub classification of HCA is based primarily on immunohistochemical analyzes, and has had an increasing impact on choice of treatment and individual prognostic assessment. This review offers an overview of the reported gene mutations associated with hepatocellular adenomas together with a discussion of the diagnostic and prognostic value.
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Affiliation(s)
- Marie B Raft
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ernö N Jørgensen
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ben Vainer
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Dhingra S, Fiel MI. Update on the new classification of hepatic adenomas: clinical, molecular, and pathologic characteristics. Arch Pathol Lab Med 2014; 138:1090-7. [PMID: 25076298 DOI: 10.5858/arpa.2013-0183-ra] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
CONTEXT Hepatic adenoma is an uncommon, benign, hepatic neoplasm that typically occurs in women of child-bearing age, often with a history of long-term use of oral contraceptive drugs. This is usually detected as an incidental mass lesion in a noncirrhotic liver during imaging studies. Pathologic evaluation by needle core biopsy remains the gold standard for diagnosis. Molecular studies have revealed that hepatic adenomas involve unique molecular pathways that are distinct from hepatocellular carcinoma. Based on these studies, a French collaborative group has recently proposed a molecular-pathologic classification for hepatic adenomas. In addition, advances in molecular studies have led to reclassification of the "telangiectatic variant of focal nodular hyperplasia" as "hepatic adenoma, inflammatory subtype." OBJECTIVE To review the proposed, new classification of hepatic adenoma and the changes in diagnostic workup in light of the above-mentioned developments. DATA SOURCES Review of published literature and illustrations from clinical case material. CONCLUSIONS Definitive diagnosis of liver mass lesion on needle core biopsies has a decisive role in clinical management. With the advent of the new classification of hepatic adenomas and its prognostic implications, it is vital for pathologists to be aware of the morphologic features seen in different subtypes and the available diagnostic tools, such as immunohistochemistry, to help identify the correct subtype.
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Affiliation(s)
- Sadhna Dhingra
- From the Lillian and Henry M. Stratton-Hans Popper Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
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ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol 2014; 109:1328-47; quiz 1348. [PMID: 25135008 DOI: 10.1038/ajg.2014.213] [Citation(s) in RCA: 278] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 05/22/2014] [Indexed: 12/11/2022]
Abstract
Focal liver lesions (FLL) have been a common reason for consultation faced by gastroenterologists and hepatologists. The increasing and widespread use of imaging studies has led to an increase in detection of incidental FLL. It is important to consider not only malignant liver lesions, but also benign solid and cystic liver lesions such as hemangioma, focal nodular hyperplasia, hepatocellular adenoma, and hepatic cysts, in the differential diagnosis. In this ACG practice guideline, the authors provide an evidence-based approach to the diagnosis and management of FLL.
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Kim SR, Kondo F, Otono Y, Imoto S, Ando K, Hirakawa M, Fukuda K, Sasaki M, Kim SK, Komaki T, Tsuchida S, Kobayashi S, Matsuoka T, Kudo M. Serum amyloid A and C-reactive protein positive nodule in alcoholic liver cirrhosis, hard to make definite diagnosis. Hepatol Res 2014; 44:584-90. [PMID: 23607539 DOI: 10.1111/hepr.12145] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 04/16/2013] [Accepted: 04/17/2013] [Indexed: 12/12/2022]
Abstract
We describe a case of serum amyloid A (SAA) and C-reactive protein (CRP) positive nodule detected by immunohistochemical analysis in a 37-year-old woman with alcohol-related cirrhosis. Imaging studies at first admission pointed to hepatocellular carcinoma (HCC), a dysplastic nodule, an inflammatory pseudotumor or focal nodular hyperplasia (FNH). Ultrasonography-guided biopsy in Segment 2 showed minimal atypical changes, except for a slight increase in cell density and micronodular cirrhosis in the non-nodular portion. gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging carried out after a year and a half revealed hypervascularity in the arterial phase and isointensity in the hepatobiliary phase. Three years thereafter, however, the imaging displayed a change from isointensity to a defect in the hepatobiliary phase, and the nodule demonstrated minimal histological atypia. Immunohistochemical staining of the nodule was positive for SAA, CRP, liver fatty acid-binding protein and glutamine synthetase, but negative for β-catenin, heat shock protein 70 and Glypican 3. Organic anion transporter (OATP)8 staining was weaker in the nodule than in the non-nodular portion of the alcohol-related micronodular cirrhosis. The nodule was diagnosed as an SAA and CRP positive nodule, and HCC was ruled out. Despite the change from isointensity to a defect in the hepatobiliary phase, no evidence of HCC was found in the biopsy specimen. The change may be explained more by the weak OATP8 staining compared with that of alcohol-related liver cirrhosis than by malignant transformation into HCC.
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Affiliation(s)
- Soo Ryang Kim
- Department of Gastroenterology, Kobe Asahi Hospital, Kobe, Japan
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Joseph NM, Ferrell LD, Jain D, Torbenson MS, Wu TT, Yeh MM, Kakar S. Diagnostic utility and limitations of glutamine synthetase and serum amyloid-associated protein immunohistochemistry in the distinction of focal nodular hyperplasia and inflammatory hepatocellular adenoma. Mod Pathol 2014; 27:62-72. [PMID: 23807780 DOI: 10.1038/modpathol.2013.114] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 05/20/2013] [Accepted: 05/21/2013] [Indexed: 12/18/2022]
Abstract
Inflammatory hepatocellular adenoma can show overlapping histological features with focal nodular hyperplasia, including inflammation, fibrous stroma, and ductular reaction. Expression of serum amyloid-associated protein in inflammatory hepatocellular adenoma and map-like pattern of glutamine synthetase in focal nodular hyperplasia can be helpful in this distinction, but the pitfalls and limitations of these markers have not been established. Morphology and immunohistochemistry were analyzed in 54 inflammatory hepatocellular adenomas, 40 focal nodular hyperplasia, and 3 indeterminate lesions. Morphological analysis demonstrated that nodularity, fibrous stroma, dystrophic blood vessels, and ductular reaction were more common in focal nodular hyperplasia, while telangiectasia, hemorrhage, and steatosis were more common in inflammatory hepatocellular adenoma, but there was frequent overlap of morphological features. The majority of inflammatory hepatocellular adenomas demonstrated perivascular and/or patchy glutamine synthetase staining (73.6%), while the remaining cases had diffuse (7.5%), negative (3.8%), or patchy pattern of staining (15%) that showed subtle differences from the classic map-like staining pattern and was designated as pseudo map-like staining. Positive staining for serum amyloid-associated protein was seen in the majority of inflammatory hepatocellular adenomas (92.6%) and in the minority of focal nodular hyperplasia (17.5%). The glutamine synthetase staining pattern was map-like in 90% of focal nodular hyperplasia cases, with the remaining 10% of cases showing pseudo map-like staining. Three cases were labeled as indeterminate and showed focal nodular hyperplasia-like morphology but lacked map-like glutamine synthetase staining pattern; these cases demonstrated a patchy pseudo map-like glutamine synthetase pattern along with the expression of serum amyloid-associated protein. Our results highlight the diagnostic errors that can be caused by variant patterns of staining with glutamine synthetase and serum amyloid-associated protein in inflammatory hepatocellular adenoma and focal nodular hyperplasia.
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Affiliation(s)
- Nancy M Joseph
- Department of Anatomic Pathology, University of California, San Francisco, CA, USA
| | - Linda D Ferrell
- Department of Anatomic Pathology, University of California, San Francisco, CA, USA
| | - Dhanpat Jain
- Department of Pathology, Yale University, New Haven, CT, USA
| | | | - Tsung-Teh Wu
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Matthew M Yeh
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Sanjay Kakar
- 1] Department of Anatomic Pathology, University of California, San Francisco, CA, USA [2] Department of Anatomic Pathology, University of California and Veteran Affairs Medical Center, San Francisco, CA, USA
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Alberti N, Frulio N, Bioulac-Sage P, Laumonier H, Balabaud C, Perez JT, Teixeira F, Harbonnier N, Trillaud H. Interest of contrast-enhanced sonography to identify focal nodular hyperplasia with sinusoidal dilatation. Diagn Interv Imaging 2014; 95:77-83. [DOI: 10.1016/j.diii.2013.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Molecular Diagnostics in the Neoplasms of the Pancreas, Liver, Gall Bladder, and Extrahepatic Biliary Tract. Clin Lab Med 2013; 33:875-80. [DOI: 10.1016/j.cll.2013.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kim H, Jang JJ, Kim DS, Yeom BW, Won NH. Clinicopathological analysis of hepatocellular adenoma according to new bordeaux classification: report of eight korean cases. KOREAN JOURNAL OF PATHOLOGY 2013; 47:411-7. [PMID: 24255628 PMCID: PMC3830987 DOI: 10.4132/koreanjpathol.2013.47.5.411] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 07/15/2013] [Accepted: 08/01/2013] [Indexed: 02/07/2023]
Abstract
Background Hepatocellular adenoma (HCA) is a rare benign tumor of the liver. A subtype classification of HCA (hepatocyte nuclear factor 1α [HNF1α]-mutated, β-catenin-mutated HCA, inflammatory HCA, and unclassified HCA) has recently been established based on a single institutional review of a HCA series by the Bordeaux group. Methods We used histologic and immunohistochemical parameters to classify and evaluate eight cases from our institution. We evaluated the new classification method and analyzed correlations between our results and those of other reports. Results Seven of our eight cases showed histologic and immunohistochemical results consistent with previous reports. However, one case showed overlapping histologic features, as previously described by the Bordeaux group. Four cases showed glutamine synthetase immunohistochemical staining inconsistent with their classification, indicating that glutamine synthetase staining may not be diagnostic for β-catenin-mutated HCA. HNF1α-mutated HCA may be indicated by the absence of liver fatty acid binding protein expression. Detection of amyloid A may indicate inflammatory HCA. HCA with no mutation in the HNF1α or β-catenin genes and no inflammatory protein expression is categorized as unclassified HCA. Conclusions Although the new classification is now generally accepted, validation through follow-up studies is necessary.
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Affiliation(s)
- Hyunchul Kim
- Department of Pathology, Gachon University Gil Medical Center, Incheon, Korea
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Thomeer MG, Willemssen FE, Biermann KK, El Addouli H, de Man RA, Ijzermans JN, Dwarkasing RS. MRI features of inflammatory hepatocellular adenomas on hepatocyte phase imaging with liver-specific contrast agents. J Magn Reson Imaging 2013; 39:1259-64. [DOI: 10.1002/jmri.24281] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 05/24/2013] [Indexed: 01/25/2023] Open
Affiliation(s)
| | | | | | | | - Rob A. de Man
- Department of Gastroenterology and Hepatology; Erasmus MC; CA Rotterdam The Netherlands
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Focal nodular hyperplasia and hepatic adenoma: current diagnosis and management. Updates Surg 2013; 66:9-21. [DOI: 10.1007/s13304-013-0222-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 06/16/2013] [Indexed: 12/25/2022]
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Marginean EC, Gown AM, Jain D. Diagnostic Approach to Hepatic Mass Lesions and Role of Immunohistochemistry. Surg Pathol Clin 2013; 6:333-365. [PMID: 26838978 DOI: 10.1016/j.path.2013.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This review provides an overview of various hepatic mass lesions and a practical diagnostic approach, including most recent immunohistochemical stains used in clinical practice. A wide variety of benign and malignant lesions present as hepatic masses, and the differential diagnosis varies. In cirrhotic liver, the commonest malignant tumor is hepatocellular carcinoma (HCC), which needs to be differentiated from macroregenerative nodules, dysplastic nodules, and other tumors. The differential diagnosis of lesions in noncirrhotic liver in younger patients includes hepatic adenoma (HA), focal nodular hyperplasia (FNH), HCC, and other primary hepatic neoplasms and metastases. In older populations, metastases remain the most common mass lesions.
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Affiliation(s)
- Esmeralda Celia Marginean
- Department of Pathology, The Ottawa Hospital, Ottawa University, CCW- Room 4251, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
| | | | - Dhanpat Jain
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06520-8023, USA
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Paradis V. Hepatocellular Adenomas: WHO Classification and Immunohistochemical Workup. Surg Pathol Clin 2013; 6:311-331. [PMID: 26838977 DOI: 10.1016/j.path.2013.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This review discusses the various subtypes of hepatocellular adenomas (HCAs), their diagnosis, and management. HCAs are benign tumors, mostly seen in young women in a normal background liver. Recent advances in understanding HCA pathogenesis and molecular alterations led to recognition of different subtypes, now included in the WHO classification. Complications include hemorrhage and rarely malignant transformation into hepatocellular carcinoma. Diagnosis and differentiation are challenging, requiring careful attention to clinical setting, histology, and immuostaining profile. Risk of complications varies depending on the HCA; hence, subtyping has clinical significance and is performed based on morphology and use of selected immunohistochemical markers.
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Affiliation(s)
- Valérie Paradis
- Pathology Department, Beaujon Hospital, 100 bvd du Général Leclerc, Clichy Cedex 92118, France; INSERM U773, Faculté de Médecine Xavier Bichat, 16 rue Henri Huchart Paris 75018, France.
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Nault JC, Bioulac-Sage P, Zucman-Rossi J. Hepatocellular benign tumors-from molecular classification to personalized clinical care. Gastroenterology 2013; 144:888-902. [PMID: 23485860 DOI: 10.1053/j.gastro.2013.02.032] [Citation(s) in RCA: 190] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 02/20/2013] [Accepted: 02/20/2013] [Indexed: 12/12/2022]
Abstract
Focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) are benign hepatocellular tumors that develop most frequently in women without cirrhosis. Genomic approaches have identified signaling pathways related to these benign hepatocyte proliferations. FNH, a polyclonal lesion, is characterized by local vascular abnormalities and heterogeneous activation of Wnt/β-catenin and transforming growth factor β signaling. Four major subgroups of HCAs have been identified based on mutations in specific oncogenes and tumor suppressor genes. Each molecular subtype of HCA has been associated with specific pathways, providing new information about benign tumorigenesis. Key features include metabolic alterations (induced by defects in HNF1A), oncogene-induced inflammation (activation of JAK-STAT signaling in inflammatory adenomas), and an association between activation of Wnt/β-catenin signaling and progression of HCAs in hepatocellular carcinomas. Benign hepatocellular tumors can be classified using immunohistochemical analyses. Studies of genotypes and phenotypes of FNH and HCAs have led to the identification of risk factors and improved invasive and noninvasive diagnostic techniques, evaluation of prognosis, and treatment. We review the molecular pathways involved in benign hepatocyte proliferation and discuss how this basic knowledge has been progressively translated into personalized clinical care.
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Affiliation(s)
- Jean-Charles Nault
- INSERM, UMR-674, Génomique Fonctionnelle des Tumeurs Solides, IUH, Paris, France
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Balabaud C, Al-Rabih WR, Chen PJ, Evason K, Ferrell L, Hernandez-Prera JC, Huang SF, Longerich T, Park YN, Quaglia A, Schirmacher P, Sempoux C, Thung SN, Torbenson M, Wee A, Yeh MM, Yeh SH, Le Bail B, Zucman-Rossi J, Bioulac-Sage P. Focal Nodular Hyperplasia and Hepatocellular Adenoma around the World Viewed through the Scope of the Immunopathological Classification. Int J Hepatol 2013; 2013:268625. [PMID: 23691331 PMCID: PMC3654480 DOI: 10.1155/2013/268625] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 12/25/2012] [Indexed: 12/14/2022] Open
Abstract
Focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) are benign hepatocellular tumors. The risk of bleeding and malignant transformation of HCA are strong arguments to differentiate HCA from FNH. Despite great progress that has been made in the differential radiological diagnosis of the 2 types of nodules, liver biopsy is sometimes necessary to separate the 2 entities. Identification of HCA subtypes using immunohistochemical techniques, namely, HNF1A-inactivated HCA (35-40%), inflammatory HCA (IHCA), and beta-catenin-mutated inflammatory HCA (b-IHCA) (50-55%), beta-catenin-activated HCA (5-10%), and unclassified HCA (10%) has greatly improved the diagnostic accuracy of benign hepatocellular nodules. If HCA malignant transformation occurs in all HCA subgroups, the risk is by far the highest in the β -catenin-mutated subgroups (b-HCA, b-IHCA). In the coming decade the management of HCA will be more dependent on the identification of HCA subtypes, particularly for smaller nodules (<5 cm) in terms of imaging, follow-up, and resection.
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Affiliation(s)
- Charles Balabaud
- Inserm U1053, Université Bordeaux Segalen, 33076 Bordeaux Cedex, France
| | | | - Pei-Jer Chen
- National Taiwan University College of Medicine, Taipei, Taiwan
- National Taiwan University Hospital, Taipei, Taiwan
| | - Kimberley Evason
- Department of Pathology, University of California, San Francisco, CA 94143-0102, USA
| | - Linda Ferrell
- Department of Pathology, University of California, San Francisco, CA 94143-0102, USA
| | | | - Shiu-Feng Huang
- National Taiwan University College of Medicine, Taipei, Taiwan
| | - Thomas Longerich
- Institute of Pathology, University Hospital, 69120 Heidelberg, Germany
| | - Young Nyun Park
- Department of Pathology, Yonsei University College of Medicine, P.O. Box 8044, Seoul, Republic of Korea
| | - Alberto Quaglia
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Peter Schirmacher
- Institute of Pathology, University Hospital, 69120 Heidelberg, Germany
| | - Christine Sempoux
- Service d'Anatomie Pathologique, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, 1200 Brussels, Belgium
| | - Swan N. Thung
- Department of Pathology, Mount Sinai School of Medicine, New York, NY 10029, USA
| | - Michael Torbenson
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aileen Wee
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, National University Hospital, National University Health System, Singapore 119074
| | - Matthew M. Yeh
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Shiou-Hwei Yeh
- National Taiwan University College of Medicine, Taipei, Taiwan
| | - Brigitte Le Bail
- Inserm U1053, Université Bordeaux Segalen, 33076 Bordeaux Cedex, France
- Pathology Department, Hôpital Pellegrin, CHU Bordeaux, 33076 Bordeaux Cedex, France
| | - Jessica Zucman-Rossi
- Inserm, UMR-674, Génomique Fonctionnelle des Tumeurs Solides, IUH, 75010 Paris, France
- Université Paris Descartes, Labex Immunooncology, Sorbonne Paris Cité, Faculté de Médecine, 75005 Paris, France
| | - Paulette Bioulac-Sage
- Inserm U1053, Université Bordeaux Segalen, 33076 Bordeaux Cedex, France
- Pathology Department, Hôpital Pellegrin, CHU Bordeaux, 33076 Bordeaux Cedex, France
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