Difference between revisions of "Hepatic adenoma"

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#redirect [[Liver_neoplasms#Hepatic_adenoma]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Hepatic_adenoma_high_mag.jpg
| Width      =
| Caption    = Hepatic adenoma. [[H&E stain]].
| Synonyms  = hepatocellular adenoma
| Micro      = sheets or cords of cells with mild variation of cell and nuclear size; cords of cells up to 3 cells thick, vascular (large arteries, dilated thin-walled veins), +/-cytoplasmic clearing/pale (due to glycogen); negatives: no bile ducts, no portal tracts, no [[cirrhosis]]
| Subtypes  = inflammatory hepatic adenoma ([[AKA]] ''telangiectatic adenoma''), hepatocyte nuclear factor 1 alpha-mutated hepatic adenoma, beta-catenin-mutated hepatic adenoma, unclassified hepatic adenoma
| LMDDx      = [[hepatocellular carcinoma]] (well-differentiated), [[focal nodular hyperplasia]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      = well-circumscribed, typically subcapsular
| Grossing  =
| Site      = [[liver]] - see ''[[liver neoplasms]]''
| Assdx      =
| Syndromes  =
| Clinicalhx = women +/-[[OCP]] use
| Signs      =
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      = subcapsular, well-circumscribed
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    =
| Tx        =
}}
'''Hepatic adenoma''', also known as '''hepatocellular adenoma''' (abbreviated '''HCA'''), is a benign [[liver neoplasms|neoplasm of the liver]].
 
==General==
*Grow under the influence of sex hormones.
**Associated with ''[[oral contraceptive pill]]'' (OCP) use<ref name=Ref_WMSP221>{{Ref WMSP|221}}</ref><ref name=pmid221698>{{Cite journal  | last1 = Rooks | first1 = JB. | last2 = Ory | first2 = HW. | last3 = Ishak | first3 = KG. | last4 = Strauss | first4 = LT. | last5 = Greenspan | first5 = JR. | last6 = Hill | first6 = AP. | last7 = Tyler | first7 = CW. | title = Epidemiology of hepatocellular adenoma. The role of oral contraceptive use. | journal = JAMA | volume = 242 | issue = 7 | pages = 644-8 | month = Aug | year = 1979 | doi =  | PMID = 221698 }}</ref> - may regress with discontinuation.
**May rupture in [[pregnancy]].
*Usually diagnosed by radiology.
 
==Gross==
Features:<ref>STC S.20, 19 Jan 2009.</ref>
*Often subcapsular location.
*Well-circumscribed, but not encapsulated.
 
==Microscopic==
Features:
*Sheets or cords of cells with mild variation of cell and nuclear size.<ref name=Ref_PBoD923>{{Ref PBoD|923}}</ref>
*Cords of cells up to 3 cells thick.<ref>STC S.19, 19 Jan 2009.</ref>
*Cells may have cytoplasmic clearing due to glycogen or be pale - '''obvious if seen'''.
*Vascular - large arteries, dilated thin-walled veins.
 
Negatives:
*No bile ducts.
*No portal tracts.
*No [[cirrhosis]]!  If cirrhosis is present it isn't a hepatic adenoma - '''important'''.
 
DDx:
*Well-differentiated [[hepatocellular carcinoma]].<ref>SN. 29 May 2009.</ref>
**Hepatic adenoma is differentiated from ''well-differentiated HCC'' by its architecture; adenomas have cords of cells upto 3 cells thick & have preserved reticulin architecture.
*[[Focal nodular hyperplasia]].
 
===Images===
<gallery>
Image:Hepatic adenoma low mag.jpg | Low mag. (WC/Nephron)
Image:Hepatic_adenoma_high_mag.jpg | High mag. (WC/Nephron)
Image:Hepatic_adenoma_low_mag_reticulin.jpg | Low mag. - reticulin (WC/Nephron)
Image:Hepatic_adenoma_high_mag_reticulin.jpg | High mag. - reticulin (WC/Nephron)
</gallery>
www:
*[http://www.ajronline.org/cgi/content-nw/full/182/6/1520/FIG3 Hepatic adenoma (ajronline.org)].
*[http://radiographics.rsna.org/content/22/5/1023.figures-only Series of liver micrographs including hepatic adenoma (radiographics.rsna.org)].
 
===Subclassification===
Based on molecular changes:<ref>{{Cite journal  | last1 = Katabathina | first1 = VS. | last2 = Menias | first2 = CO. | last3 = Shanbhogue | first3 = AK. | last4 = Jagirdar | first4 = J. | last5 = Paspulati | first5 = RM. | last6 = Prasad | first6 = SR. | title = Genetics and imaging of hepatocellular adenomas: 2011 update. | journal = Radiographics | volume = 31 | issue = 6 | pages = 1529-43 | month = Oct | year = 2011 | doi = 10.1148/rg.316115527 | PMID = 21997980 }}</ref><ref name=pmid21883740>{{Cite journal  | last1 = Sasaki | first1 = M. | last2 = Yoneda | first2 = N. | last3 = Kitamura | first3 = S. | last4 = Sato | first4 = Y. | last5 = Nakanuma | first5 = Y. | title = Characterization of hepatocellular adenoma based on the phenotypic classification: The Kanazawa experience. | journal = Hepatol Res | volume = 41 | issue = 10 | pages = 982-8 | month = Oct | year = 2011 | doi = 10.1111/j.1872-034X.2011.00851.x | PMID = 21883740 }}</ref>
#Inflammatory hepatic adenoma.
#*[[AKA]] ''telangiectatic adenoma''.<ref>{{Cite journal  | last1 = Maylee | first1 = H. | last2 = Harada | first2 = K. | last3 = Igarashi | first3 = S. | last4 = Tohda | first4 = G. | last5 = Yamamoto | first5 = M. | last6 = Ren | first6 = XS. | last7 = Osawa | first7 = T. | last8 = Hasegawa | first8 = Y. | last9 = Takahashi | first9 = N. | title = Case of telangiectatic/inflammatory hepatocellular adenoma arising in a patient with primary sclerosing cholangitis. | journal = Hepatol Res | volume = 42 | issue = 6 | pages = 611-8 | month = Jun | year = 2012 | doi = 10.1111/j.1872-034X.2011.00962.x | PMID = 22568458 }}
</ref>
#*Associated with obesity.{{fact}}
#Hepatocyte nuclear factor 1 alpha-mutated hepatic adenoma.
#*Inactivating mutation.
#Beta-catenin-mutated hepatic adenoma
#*Activating mutation.
#Unclassified hepatic adenoma.
 
Note:
*Beta-catenin is considered an [[oncogene]].
 
==IHC==
*[[AFP]] -ve. (???)
*HNF1alpha +ve/-ve.
*Beta-catenin +ve/-ve.
 
==See also==
*[[Liver neoplasms]].
*[[Hepatocellular carcinoma]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Liver neoplasms]]

Latest revision as of 21:54, 29 September 2015

Hepatic adenoma
Diagnosis in short

Hepatic adenoma. H&E stain.
Synonyms hepatocellular adenoma
LM sheets or cords of cells with mild variation of cell and nuclear size; cords of cells up to 3 cells thick, vascular (large arteries, dilated thin-walled veins), +/-cytoplasmic clearing/pale (due to glycogen); negatives: no bile ducts, no portal tracts, no cirrhosis
Subtypes inflammatory hepatic adenoma (AKA telangiectatic adenoma), hepatocyte nuclear factor 1 alpha-mutated hepatic adenoma, beta-catenin-mutated hepatic adenoma, unclassified hepatic adenoma
LM DDx hepatocellular carcinoma (well-differentiated), focal nodular hyperplasia
Gross well-circumscribed, typically subcapsular
Site liver - see liver neoplasms
Clinical history women +/-OCP use
Prevalence uncommon
Radiology subcapsular, well-circumscribed
Prognosis benign

Hepatic adenoma, also known as hepatocellular adenoma (abbreviated HCA), is a benign neoplasm of the liver.

General

  • Grow under the influence of sex hormones.
  • Usually diagnosed by radiology.

Gross

Features:[3]

  • Often subcapsular location.
  • Well-circumscribed, but not encapsulated.

Microscopic

Features:

  • Sheets or cords of cells with mild variation of cell and nuclear size.[4]
  • Cords of cells up to 3 cells thick.[5]
  • Cells may have cytoplasmic clearing due to glycogen or be pale - obvious if seen.
  • Vascular - large arteries, dilated thin-walled veins.

Negatives:

  • No bile ducts.
  • No portal tracts.
  • No cirrhosis! If cirrhosis is present it isn't a hepatic adenoma - important.

DDx:

Images

  • Low mag. (WC/Nephron)

  • High mag. (WC/Nephron)

  • Low mag. - reticulin (WC/Nephron)

  • High mag. - reticulin (WC/Nephron)

www:

Subclassification

Based on molecular changes:[7][8]

  1. Inflammatory hepatic adenoma.
  2. Hepatocyte nuclear factor 1 alpha-mutated hepatic adenoma.
    • Inactivating mutation.
  3. Beta-catenin-mutated hepatic adenoma
    • Activating mutation.
  4. Unclassified hepatic adenoma.

Note:

IHC

  • AFP -ve. (???)
  • HNF1alpha +ve/-ve.
  • Beta-catenin +ve/-ve.

See also

References

  1. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 221. ISBN 978-0781765275.
  2. ↑ Rooks, JB.; Ory, HW.; Ishak, KG.; Strauss, LT.; Greenspan, JR.; Hill, AP.; Tyler, CW. (Aug 1979). "Epidemiology of hepatocellular adenoma. The role of oral contraceptive use.". JAMA 242 (7): 644-8. PMID 221698.
  3. ↑ STC S.20, 19 Jan 2009.
  4. ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 923. ISBN 0-7216-0187-1.
  5. ↑ STC S.19, 19 Jan 2009.
  6. ↑ SN. 29 May 2009.
  7. ↑ Katabathina, VS.; Menias, CO.; Shanbhogue, AK.; Jagirdar, J.; Paspulati, RM.; Prasad, SR. (Oct 2011). "Genetics and imaging of hepatocellular adenomas: 2011 update.". Radiographics 31 (6): 1529-43. doi:10.1148/rg.316115527. PMID 21997980.
  8. ↑ Sasaki, M.; Yoneda, N.; Kitamura, S.; Sato, Y.; Nakanuma, Y. (Oct 2011). "Characterization of hepatocellular adenoma based on the phenotypic classification: The Kanazawa experience.". Hepatol Res 41 (10): 982-8. doi:10.1111/j.1872-034X.2011.00851.x. PMID 21883740.
  9. ↑ Maylee, H.; Harada, K.; Igarashi, S.; Tohda, G.; Yamamoto, M.; Ren, XS.; Osawa, T.; Hasegawa, Y. et al. (Jun 2012). "Case of telangiectatic/inflammatory hepatocellular adenoma arising in a patient with primary sclerosing cholangitis.". Hepatol Res 42 (6): 611-8. doi:10.1111/j.1872-034X.2011.00962.x. PMID 22568458.
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