Inflammatory Hepatocellular Adenoma with Elevated Serum Protein Induced by Vitamin K Absence/Antagonist-II in Adult Males

Abstract

Two men (24 and 34 years of age) with a single hypervascular liver tumor were admitted to our hospital. The tumors were diagnosed as hepatocellular adenoma (HCA) by an ultrasound-guided biopsy and classified as inflammatory type by immunohistochemical staining. Considering the risk of malignant transformation, they underwent surgical resection. Although the serum levels of protein induced by vitamin K absence/antagonist-II (PIVKA-II) were slightly elevated, they normalized after the resection. The diagnosis of HCA including malignant transformation is often difficult by image findings alone. Careful immunohistochemical examinations are very useful for the diagnosis and classification of subgroups, including malignant transformation. In addition, we proved that HCA without malignant transformation expresses PIVKA-II.

Unclassified hepatic hepatocellular adenoma in men still a diagnosis by exclusion: Case report and review of the literature.

“…Hyperintensity along with central scar was in favor of ß-catenin-mutated hepatocellular adenoma with an area under the curve of 0,903 [14]. In front of doubtful diagnosis, percutaneous biopsy may be useful as in our case [15]. In disagreement with the literature, magnetic resonance imaging was unable to bring out numerous superficial lesions in the right hepatic lobe for our case may be secondary to the superficial localization and the small size.…”

“…The high risk of malignant transformation especially in male gender led to proposing liver resection: 47% in male gender versus 4% in female gender [1]. The other predictive factors for malignant transformation were exogenous steroids prolonged intake, obesity, metabolic syndrome, a tumor size over 5 cm as in our case, type 1a glycogen storage disease, and beta-catenin activation in exon 3 [10,15]. Surgical resection is still a cornerstone for the treatment of such tumors especially in case of bleeding risk: diameter superior or equal to 3.5 cm, visualization of lesional arteries, left lateral liver location, and exophytic growth as for our case [17].…”

Unclassified hepatocellular adenoma with histological brown pigment deposition and serum PIVKA-II level elevation: a case report

“…In this case, the serum level of PIVKA-II was very high, but it is usually negative in cases of HCA. A PubMed search of the keywords "hepatocellular adenoma" and "PIVKA-II or DCP" (i.e., HCA cases showing high serum levels of PIVKA-II) yielded seven reports (Table 2) [19,[21][22][23][24][25]. The average age of the patients was 34 years (range, 21-57), with a male to female ratio of 1:1 when we include the present case.…”

“…There have been two reported cases of malignant transformation of HCA [18,21]. The concept of subtype classification was proposed in 2010, and there were only four cases with reference to the subtype, and two cases of lipofuscin deposition [24]. For treatment, hepatectomy was performed in all cases because a malignant transformation was possible, as indicated by the high level of serum PIVKA-II.…”