HEPATOSELÜLER ADENOMA PATOLOJISI: ALT TIPLERI VE NADIR GÖRÜLEN MORFOLOJIK ÖZELLIKLERI

Ecem Çağla Hayırlıoğlu; Hristina Fotioğlu; Hale Kırımlıoğlu

EN TR

Pathology of Hepatocellular Adenoma: Subtypes and Rare Morphologic Features

Abstract

Background: The molecular classification has been divided HCA into four main subgroups: hepatocyte-nuclear-factor-1a mutated H-HCA , B-catenin type HA-B , inflammatory type HA-I and unclassified type. Those subgroups were linked with risk factors, clinical behavior, histological features, imaging and malignant transformation. Subtyping is useful to predict HA’s behavior and also to detect morphology which may have the potential to affect the prognosis. We aimed to review subtype features of our hepatocellular adenoma cases and discuss the importance of the rare morphologic features.Methods: Fifteen Hepatocellular adenoma cases 10 resections, 3 explants and 2 biopsies were included in this study. Hematoxylin and eosin H&E stained slides, Reticulin and Masson’s trichrome stains, as well as immunohistochemical studies IHC , were used to evaluate general morphologic and immunophenotypic features performed with B-catenin, SAA amyloid and Glutamine Synthetase GS using standard laboratory techniques in the Ventana Benchmark Ultra platform. CD34 immunohistochemical stains were performed on atypical cases to evaluate the presence of vascularization.Results: By morphologic features and Immunohistochemistry, 3 HA-B %20 , 4 HA-I %26.6 , 4 HA-H %26.6 and 4 HA-U %26.6 cases were classified. Two HA cases had Dubin-Johnson pigment and Two of the beta-catenin mutated HAs had bone marrow metaplasia. In one of the cases, malignant transformation in the HA was present. The microscopic findings included hemorrhage, pigment formation, granuloma formation, presence of inflammation, presence and degree of steatosis, preserved or non-preserved reticulin network.Conclusions: Besides the classic morphologic features; granuloma formation, pigmentation, bone marrow metaplasia can be seen in HAs. Although the prognostic significance of those is not known, they are considered to have a role in the development and progression of HA

Keywords

Liver,hepatocellular adenoma,pathology

HEPATOSELÜLER ADENOMA PATOLOJISI: ALT TIPLERI VE NADIR GÖRÜLEN MORFOLOJIK ÖZELLIKLERI

Öz

Amaç: Hepatoseluler Adenoma moleküler sınıflandırmada, dört ana alt gruba ayrilmistir: Mutasyona uğramış hepatosit-nükleer faktör-1a Hepatoseluler Adenoma H-HCA , B-catenin tip Hepatoseluler Adenoma HA-B , Enflamatuar tip Hepatoseluler Adenoma HA-I ve sınıflandırılamayan tip. Bu alt gruplar risk faktörleri, klinik davranış, histolojik özellikler, görüntüleme ve malign transformasyon ile ilişkilendirilir. Hepatoseluler adenomayi siniflandirmak, davranışını tahmin etmek ve ayrıca prognozu etkileme potansiyeli olabilecek morfolojiyi saptamak için yararlıdır. Hepatosellüler adenoma olgularımızın, subtip özelliklerini gözden geçirmeyi ve nadir görülen morfolojik özelliklerin önemini tartışmayı amaçladık

Anahtar Kelimeler

Karaciğer,hepatoselüler adenoma,patoloji

References

NaultJC,Bioulac-SageP,Zucman-RossiJ.Hepatocellular benign tumors-from molecular classiŞcation to personalized clinical care. Gastroenterology2013;144:888–902. [CrossRef]
Dhingra S, Fiel MI. Update on the New Classification of Hepatic Adenomas Clinical, Molecular, and Pathologic Characteristics. Arch Pathol Lab Med. 2014;138:1090–97 [CrossRef]
Bioulac-Sage P, Laumonier H, Couchy G, et al. Hepatocellular adenoma management and phenotypic classiŞcation: the Bordeaux experience. Hepatology 2009;50:481–9. [CrossRef]
Dokmak S, Paradis V, Vilgrain V, et al. A single-center surgical experience of 122 patients with single and multiple hepatocellular adenomas. Gastroenterology 2009;137:1698–705. [CrossRef]
van Aalten SM, de Man RA, JN IJ, et al. Systematic review of haemorrhage and rupture of hepatocellular adenomas. British J Surg 2012, 99:911-6. [CrossRef] https://doi.org/10.1002/bjs.8762
EASL Clinical Practice Guidelines on the management of benign liver tumours.J Hepatol 2016,65:386-398. [CrossRef]
Nault JC , Couchy G, Balabaud C et al. Molecular classification of hepatocellular adenoma associates with risk factors, bleeding, and malignant transformation. Gastroenterology 2017, 152: 880-94. [CrossRef]
Zucman-Rossi J, Jeannot E, Nhieu JT, et al. Genotype-phenotype correlation in hepatic adenoma: new classification and relationship with HCC. Hepatology. 2006;43:515–24. [CrossRef]

Farges O, Dokmak S. Malignant transformation of liver adenoma: an analysis of the literature. Dig Surg. 2010:27:32–8. [CrossRef]
Margolskee E, Bao F, Gonzales AK et al. Hepatocellular adenoma classification: a comparative evaluation of immunohistochemistry and targeted mutational analysis. Diagn Pathol. 2016;11:27. [CrossRef]
Ramacciato G, Nigri GR, Aurello P et al Giant hepatic adenoma with bone marrow metaplasia not associated with oral contraceptive intake.World J Surg Oncol. 2006; 4: 58. [CrossRef]
Iguchi T, Yamagata M, Sonoda T et al.Malignant transformation of hepatocellular adenoma with bone marrow metaplasia arising in glycogen storage disease type I: A case report. Mol Clin Oncol. 2016 Nov; 5: 599–603. [CrossRef]
Moriura S, Kuroda M, Kimura A, Iwatsuka Y, Ikeda S, Sakai T, Usui A.Case report: hepatic adenoma with bone marrow metaplasia in a patient with glycogen storage disease type 1a. J Gastroenterol Hepatol. 1996 Jun;11:556-9. [CrossRef]
Kang HJ, Jeon HJ, Kim SW et al. Hepatocellular Carcinoma Arising in a Huge Hepatocellular Adenoma with Bone Marrow Metaplasia. J Pathology Translational Medicine. Published online: December 27, 2017. [CrossRef]
Herzog EL, Chai L, Krause DS. Plasticity of marrow-derived stem cells. Blood. 2003;102:3483–93. [CrossRef]
Copin P,Ronot M, Vilgrain V. Hepatocellular Carcinoma With Osseous Metaplasia and Bone Marrow Elements. Clinical Gastroenterology and Hepatology March 2015;13: 26–7. [CrossRef]
Bieze M, Bioulac-Sage P, Verheij J et al. Hepatocellular Adenomas Associated with Hepatic Granulomas: Experience in Five Cases. Case Rep Gastroenterol. 2012 Sep-Dec; 6: 677–83. [CrossRef]
Malatjalian DA, Graham CH.Liver adenoma with granulomas. The appearance of granulomas in oral contraceptive-related hepatocellular adenoma and in the surrounding nontumorous liver. Arch Pathol Lab Med. 1982 May;106:244-6.
Weinstein DA, Roy CN, Fleming MD et al. Inappropriate expression of hepcidin is associated with iron refractory anemia: implications for the anemia of chronic disease. Blood, 2002, 100: 3776–81. [CrossRef]
Mounajjed T, Yasir S, Aleff PA, Torbenson MS.Pigmented hepatocellular adenomas have a high risk of atypia and malignancy. Mod Pathol. 2015 Sep;28:1265-74. [CrossRef]
Hechtman JF, Raoufi M, Fiel MI et al., Hepatocellular carcinoma arising in a pigmented telangiectatic adenoma with nuclear β-catenin and glutamine synthetase positivity: case report and review of the literature. The American Journal of Surgical Pathology, 2011 35:927–32. [CrossRef]
Masuda T, Beppu T, Ikeda K et al.Pigmented hepatocellular adenoma: report of a case. Surgery Today, 2011, 41: 881–3. [CrossRef]
Hasan N, Coutts M, Portmann B. Pigmented liver cell adenoma in two male patients. The American Journal of Surgical Pathology, 2000, 24:1429–32. [CrossRef]

Details

Primary Language

Turkish

Subjects

-

Journal Section

-

Authors

Ecem Çağla Hayırlıoğlu

Hristina Fotioğlu

Hale Kırımlıoğlu

Publication Date

March 1, 2020

Submission Date

-

Acceptance Date

-

Published in Issue

Year 2020 Number: 1

IZ

https://izlik.org/JA56HU44HJ

Cite

RIS / Bibtex

EndNote

Hayırlıoğlu EÇ, Fotioğlu H, Kırımlıoğlu H (March 1, 2020) HEPATOSELÜLER ADENOMA PATOLOJISI: ALT TIPLERI VE NADIR GÖRÜLEN MORFOLOJIK ÖZELLIKLERI. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 1 8–13.