Hepatic adenoma

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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

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.