Giant hepatic adenoma with bone marrow metaplasia not associated with oral contraceptive intake

Ramacciato, Giovanni; Nigri, Giuseppe; Aurello, Paolo; D’Angelo, Francesco; Pezzoli, Francesca; Rossi, Símone; Pilozzi, Emanuela; Ercolani, Giorgio; Ravaioli, Matteo

doi:10.1186/1477-7819-4-58

Cited by 6 publications

(5 citation statements)

References 14 publications

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“…In literature, four HA cases were presented having bone marrow metaplasia (11,12,13,14), two of them were discovered in a glycogen-storage disease-associated hepatic adenoma (12,13), none of them were associated with oral contraceptive use. All were big masses and two of them were giant hepatic adenomas (11,14). Two of the case had hepatocellular carcinoma arising in the hepatic adenoma (12,14).…”

Section: Discussionmentioning

confidence: 99%

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Hepatoselüler Adenoma Patolojisi: Alt Tipleri ve Nadir Görülen Morfolojik Özellikleri

Hayirlioğlu¹,

Fotioğlu²,

Kırımlıoğlu³

2020

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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.

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Section: Discussionmentioning

confidence: 99%

“…At that point, stem cells could differentiate into hepatic progenitor cells and then into mature hepatocytes. Hepatic progenitor cells have also a role in human liver tumor development (11). Bone marrow metaplasia was reported in some of the hepatocellular carcinomas as well (16).…”

Section: Discussionmentioning

confidence: 99%

Hepatoselüler Adenoma Patolojisi: Alt Tipleri ve Nadir Görülen Morfolojik Özellikleri

Hayirlioğlu¹,

Fotioğlu²,

Kırımlıoğlu³

2020

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“…According to a review of the literature, this represents the first case report of HCC arising from HCA with complete bone marrow metaplasia consisting of both fat components and hematopoietic cells in an adult younger than 30 years old. It has been previously demonstrated that bone marrow-derived stem cells can differentiate into hepatic progenitor cells that may play a role in liver tumor development [ 10 , 20 ]. In this present case, hepatic progenitor cells with epithelial cell adhesion molecule expression ( Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Risk factors for HCC from HCA include male sex, androgen use, large tumor size (> 5 cm), and β-catenin-activated subtype [ 4 , 6 ]. Bone marrow metaplasia has been very rarely reported in primary liver tumors; indeed, only four such cases have been reported to date [ 7 - 10 ]. Here, we report for the first time in Korea a case of HCC arising from a β-catenin–activated inflammatory HCA with bone marrow metaplasia in a young woman who had not taken OCPs.…”

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confidence: 99%

Hepatocellular Carcinoma Arising in a Huge Hepatocellular Adenoma with Bone Marrow Metaplasia

Kang

Jeong

Kim

et al. 2018

J Pathol Transl Med

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Hepatocellular adenoma (HCA) is the most common type of benign liver tumor, and its major complication is malignant transformation to hepatocellular carcinoma (HCC). Here, we report a case of HCC arising in HCA with bone marrow metaplasia in a 24-year-old Korean woman who presented with abdominal discomfort. A huge liver mass was found on abdominal ultrasonography. She underwent surgical hepatic resection, and the resected specimen was entirely involved by a 20-cm-sized tumor. Histological review revealed a well differentiated HCC arising from inflammatory HCA with β-catenin nuclear positivity and bone marrow metaplasia that contained hematopoietic cells. This case was unique because malignant transformation, inflammatory type HCA, β-catenin nuclear staining, and bone marrow metaplasia were simultaneously observed. Additionally, it should be noted that a large HCA with β-catenin activation can undergo malignant transformation and should be surgically resected in a timely manner.

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“…Hepatocellular adenoma is the most common benign liver tumours. CT-scan can show a well circumscribed and often encapsulated mass has a low density on non-contest phase, a marked centripetal pattern of enhancement on a phase and a central necrotic area or calcifications [6]. Cystic lesions are readily identified and abscesses are usually distinguished from tumours [7].…”

Section: Introductionmentioning

confidence: 99%

Test Accuracy of CT-Scan for the Detection of Malignant Liver Mass

Begum¹,

Bhowmik²,

Hussain³

et al. 2015

ACT

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and DMCH with the clinical diagnosis of fever, abdominal pain, anorexia, nausea/vomiting, loss of appetite, jaundice, weight loss and ascites were selected as study population. CT scan and histopathology were performed to all the patients. Result: A total number of 50 patients were recruited for this study. Mean age of all patients was 51.28 ± 14 years with a range of 17 year to 78 years. Among all patients 28 had multiple lesion, of them 71.4% was malignant and 28.6% was benign. On the other side 22 patients had solitary lesion, of them 36.4% was malignant and 63.6% was benign (p < 0.05). Sensitivity of CT to diagnose malignant lesion was 96.4%, specificity 86.4%, accuracy 92%, positive predictive value 90% and negative predictive value 95%. Conclusion: CT is a useful diagnostic tool for the detection of malignant hepatic masses.

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Giant hepatic adenoma with bone marrow metaplasia not associated with oral contraceptive intake

Cited by 6 publications

References 14 publications

Hepatoselüler Adenoma Patolojisi: Alt Tipleri ve Nadir Görülen Morfolojik Özellikleri

Hepatoselüler Adenoma Patolojisi: Alt Tipleri ve Nadir Görülen Morfolojik Özellikleri

Hepatocellular Carcinoma Arising in a Huge Hepatocellular Adenoma with Bone Marrow Metaplasia

Test Accuracy of CT-Scan for the Detection of Malignant Liver Mass

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