scholarly journals Histological and Immunohistochemical Revision of Hepatocellular Adenomas: A Learning Experience

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
S. Fonseca ◽  
D. Hoton ◽  
S. Dardenne ◽  
L. Annet ◽  
C. Hubert ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Malignant Transformation ◽  
Surgical Resection ◽  
Immunohistochemical Staining ◽  
Learning Experience ◽  
Hepatocellular Adenoma ◽  
Phenotype Correlation ◽  
Vascular Abnormalities ◽  
Sinusoidal Dilatation ◽  
Hepatocellular Adenomas

Light has been shed on the genotype/phenotype correlation in hepatocellular adenoma (HCA) recognizingHNF1α-inactivated HCA (H-HCA), inflammatory HCA (IHCA), andβ-catenin-activated HCA (b-HCA). We reviewed retrospectively our surgical HCA series to learn how to recognize the different subtypes histopathologically and how to interpret adequately their immunohistochemical staining. From January 1992 to January 2012, 37 patients underwent surgical resection for HCA in our institution. Nine had H-HCA (25%) characterized by steatosis and loss of L-FABP expression; 20 had IHCA (55.5%) showing CRP and/or SAA expression, sinusoidal dilatation, and variable inflammation; and 1 patient had both H-HCA and IHCA. In 5 patients (14%), b-HCA with GS andβ-catenin nuclear positivity was diagnosed, two already with hepatocellular carcinoma. Two cases (5.5%) remained unclassified. One of the b-HCA showed also the H-HCA histological and immunohistochemical characteristics suggesting a subgroup ofβ-catenin-activated/HNF1α-inactivated HCA, another b-HCA exhibited the IHCA histological and immunohistochemical characteristics suggesting a subgroup ofβ-catenin-activated/inflammatory HCA. Interestingly, three patients had underlying vascular abnormalities. Using the recently published criteria enabled us to classify histopathologically our retrospective HCA surgical series with accurate recognition of b-HCA for which we confirm the higher risk of malignant transformation. We also underlined the association between HCA and vascular abnormalities.

scholarly journals MR Imaging of Hepatocellular Adenomas and Differential Diagnosis Dilemma

2013 ◽  
Vol 2013 ◽  
pp. 1-20 ◽  
Author(s):  
Luigi Grazioli ◽  
Lucio Olivetti ◽  
Giancarlo Mazza ◽  
Maria Pia Bondioni
Keyword(s):  
Differential Diagnosis ◽  
Malignant Transformation ◽  
Fatty Infiltration ◽  
Hepatocellular Adenoma ◽  
Malignant Degeneration ◽  
Dual Phase ◽  
Genetic Abnormalities ◽  
Malignant Lesions ◽  
Nuclear Factor 1 ◽  
Hepatocellular Adenomas

Hepatocellular adenomas (HCAs) are currently categorized into distinct genetic and pathologic subtypes as follows: inflammatory hepatocellular adenoma, hepatocyte-nuclear-factor-1-alpha (HNF-1α-mutated) hepatocellular adenoma, andβ-catenin-mutated hepatocellular adenomas; the fourth, defined as unclassified subtype, encompasses HCAs without any genetic abnormalities. This classification has accepted management implications due to different risks of haemorrhage and malignant transformation of the four subtypes. Imaging guided biopsy and/or surgical resection very important in obtaining definitive characterization; nevertheless, MRI with intra-extravascular and hepatobiliary (dual phase) agents, is an important tool not only in differential subtypes definition but even in surveillance with early identification of complications and discovery of some signs of HCA malignant degeneration. Inflammation, abnormal rich vascularisation, peliotic areas, and abundant fatty infiltration are pathologic findings differently present in the HCA subtypes and they may be detected by multiparametric MRI approach. Lesion enlargement and heterogeneity of signal intensity and of contrast enhancement are signs to be considered in malignant transformation. The purpose of this paper is to present the state of the art of MRI in the diagnosis of HCA and subtype characterization, with particular regard to morphologic and functional information available with dual phase contrast agents, and to discuss differential diagnosis with the most common benign and malignant lesions mimicking HCAs.

scholarly journals Malignant Transformation of an HNF1a-Inactivated Hepatocellular Adenoma to Hepatocellular Carcinoma

2020 ◽  
Vol 14 (3) ◽  
pp. 577-585
Author(s):  
Joris T. Hepkema ◽  
Floris B. Poelmann ◽  
Annette S.H. Gouw ◽  
Robbert J. de Haas ◽  
Evelien W. Duiker ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Malignant Transformation ◽  
Histopathological Examination ◽  
Imaging Techniques ◽  
Hepatocellular Adenoma ◽  
Benign Tumors ◽  
Palpable Mass ◽  
Contrast Enhanced ◽  
Enhanced Computed Tomography ◽  
Upper Abdomen

Hepatocellular adenomas (HCA) are rare benign tumors of the liver, occurring predominantly in females using oral contraceptives. Our case describes a 66-year-old woman presenting with a palpable mass in her upper abdomen. Contrast-enhanced computed tomography and magnetic resonance imaging showed a large exophytic mass protruding from the caudal border of liver segments IV and V, without visible metastases. Laparoscopic resection of the tumor and gallbladder was performed. Histopathological examination showed a hepatocellular carcinoma with areas of HNF1a-HCA (H-HCA). This case shows that malignant transformation is possible in H-HCA. We present our preoperative decision-making process, as well as the role of imaging techniques in this rare case.

scholarly journals Risk factors for malignant transformation of hepatocellular adenoma to hepatocellular carcinoma: protocol for systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e045733
Author(s):  
Tharusan Thevathasan ◽  
Teresa Colbatzky ◽  
Moritz Schmelzle ◽  
Johann Pratschke ◽  
Felix Krenzien
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Systematic Review ◽  
Malignant Transformation ◽  
Meta Analysis ◽  
Hepatocellular Adenoma ◽  
Assessment Tools ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Modifiable Factors

IntroductionHepatocellular adenomas (HCAs) are solid liver tumours that are usually found incidentally during routine medical check-ups. Multiple modifiable and non-modifiable factors constitute a risk for the malignant transformation of HCAs to hepatocellular carcinoma (HCC), which has emerged to be one of the fastest growing causes of cancer-related mortality globally. This study protocol for a planned systematic review and meta-analysis documents the methodological approach to identify risk factors and their risk estimates for the transformation from HCA to HCC.Methods and analysisTwo independent reviewers will systematically search and extract data from studies in patients of all ages published between January 1970 and June 2021 on PubMed, MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Scopus Web of Science, Ovid, The Cochrane Hepatobiliary Group Controlled Trials Register and The Cochrane Central Register of Controlled Trials by using an a priori defined search strategy. Study quality will be rated with the National Institute of Health quality assessment tools. Disagreements will be resolved by consensus with a third independent reviewer. The primary outcome will be the odds ratio (OR) of developing HCC in patients with prediagnosed HCA depending on the exposure to risk factors. HCC diagnosis must be inferred based on imaging techniques or pathology. We will use R V.4.0.2 to conduct meta-analyses and generate pooled ORs based on random effects models. Results will be presented as forest plots. Cochran’s Q and I2 test will be performed to assess heterogeneity between included studies. Funnel plots and Egger’s weighted regression will be used to evaluate publication bias.Ethics and disseminationNo ethical approval is required as we will use and analyse data from previously published studies in which informed consent was obtained. The results will be disseminated in a peer-reviewed journal on completion.PROSPERO registration numberCRD42020206578.

scholarly journals Is the Rationale of Anatomical Liver Resection for Hepatocellular Carcinoma Universally Adoptable? A Hypothesis-Driven Review

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 131
Author(s):  
Young-Jen Lin ◽  
Cheng-Maw Ho
Keyword(s):  
Hepatocellular Carcinoma ◽  
Tumor Microenvironment ◽  
Surgical Resection ◽  
Tumor Recurrence ◽  
Hepatic Metastases ◽  
Vascular Supply ◽  
Tumor Ablation ◽  
Supporting Evidence ◽  
En Bloc ◽  
Margin Width

Surgical resection is the first-line curative treatment modality for resectable hepatocellular carcinoma (HCC). Anatomical resection (AR), described as systematic removal of a liver segment confined by tumor-bearing portal tributaries, may improve survival by reducing the risk of tumor recurrence compared with non-AR. In this article, we propose the rationale for AR and its universal adoption by providing supporting evidence from the advanced understanding of a tumor microenvironment and accumulating clinical experiences of locoregional tumor ablation therapeutics. AR may be advantageous because it completely removes the en-bloc by interrupting tumor vascular supply and thus extirpates the spreading of tumor microthrombi, if they ever exist, within the supplying portal vein. However, HCC is a hypervascular tumor that can promote neoangiogenesis in the local tumor microenvironment, which in itself can break through the anatomical boundary within the liver and even retrieve nourishment from extrahepatic vessels, such as inferior phrenic or omental arteries. Additionally, increasing clinical evidence for locoregional tumor ablation therapies, such as radiofrequency ablation, predominantly performed as a non-anatomical approach, suggests comparable outcomes for surgical resection, particularly in small HCC and colorectal, hepatic metastases. Moreover, liver transplantation for HCC, which can be considered as AR of the whole liver followed by implantation of a new graft, is not universally free from post-transplant tumor recurrence. Overall, AR should not be considered the gold standard among all surgical resection methods. Surgical resection is fundamentally reliant on choosing the optimal margin width to achieve en-bloc tumor niche removal while balancing between oncological radicality and the preservation of postoperative liver function. The importance of this is to liberate surgical resilience in hepatocellular carcinoma. The overall success of HCC treatment is determined by the clearance of the theoretical niche. Developing biomolecular-guided navigation device/technologies may provide surgical guidance toward the total removal of microscopic tumor niche to achieve superior oncological outcomes.

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