Hepatocellular adenoma pathophysiology: Difference between revisions
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* The cut surface may be solid tan or yellow depending upon the presence or absence of steatosis. | * The cut surface may be solid tan or yellow depending upon the presence or absence of steatosis. | ||
* The intratumoral hemorrhage can give rise to a soft, necrotic, red brown lesion. | * The intratumoral hemorrhage can give rise to a soft, necrotic, red brown lesion. | ||
* Tumor hepatocytes have cytoplasm that may be normal, clear (glycogen rich), steatotic or contain pigment in the lysosomes. Nuclear atypia and mitosis are unusual but may be seen in specific variants.<ref name="NaultParadis2017">{{cite journal|last1=Nault|first1=Jean-Charles|last2=Paradis|first2=Valérie|last3=Cherqui|first3=Daniel|last4=Vilgrain|first4=Valérie|last5=Zucman-Rossi|first5=Jessica|title=Molecular classification of hepatocellular adenoma in clinical practice|journal=Journal of Hepatology|volume=67|issue=5|year=2017|pages=1074–1083|issn=01688278|doi=10.1016/j.jhep.2017.07.009}}</ref> | * Tumor hepatocytes have cytoplasm that may be normal, clear (glycogen rich), steatotic or contain pigment in the lysosomes. Nuclear atypia and mitosis are unusual but may be seen in specific variants.<ref name="NaultParadis2017">{{cite journal|last1=Nault|first1=Jean-Charles|last2=Paradis|first2=Valérie|last3=Cherqui|first3=Daniel|last4=Vilgrain|first4=Valérie|last5=Zucman-Rossi|first5=Jessica|title=Molecular classification of hepatocellular adenoma in clinical practice|journal=Journal of Hepatology|volume=67|issue=5|year=2017|pages=1074–1083|issn=01688278|doi=10.1016/j.jhep.2017.07.009}}</ref><ref>{{Cite journal | ||
| author = [[L. M. Franco]], [[V. Krishnamurthy]], [[D. Bali]], [[D. A. Weinstein]], [[P. Arn]], [[B. Clary]], [[A. Boney]], [[J. Sullivan]], [[D. P. Frush]], [[Y.-T. Chen]] & [[P. S. Kishnani]] | |||
| title = Hepatocellular carcinoma in glycogen storage disease type Ia: a case series | |||
| journal = [[Journal of inherited metabolic disease]] | |||
| volume = 28 | |||
| issue = 2 | |||
| pages = 153–162 | |||
| year = 2005 | |||
| month = | |||
| doi = 10.1007/s10545-005-7500-2 | |||
| pmid = 15877204 | |||
}}</ref> | |||
==Microscopic Pathology== | ==Microscopic Pathology== | ||
Revision as of 22:45, 27 December 2018
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Hepatocellular adenoma Microchapters |
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Hepatocellular adenoma pathophysiology On the Web |
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Risk calculators and risk factors for Hepatocellular adenoma pathophysiology |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zahir Ali Shaikh, MD[2]
Overview
Pathophysiology
- The exact pathogenesis of hepatocellular adenoma is still unknown, however, its association with oral contraceptive use is well established.[1]
- In 1973, Baum et al first described the causal association of hepatocellular adenoma with oral contraceptive use.
- In 1979, Rooks et al reported the relationship with oral contraceptive use to be dose and duration dependent and is highest in women over 30 years of age after using oral contraceptive for more than 24 months.
- Hepatocellular adenoma has also been associated with long term use of anabolic androgenic steroids and glycogen storage diseases.
- Other rare causal associations include; familial adenomatous polyposis, maturity onset diabetes of young, obesity, metabolic syndrome and vascular disorders like portal vein agenesis, budd chiari syndrome and hereditary hemmorhagic telangeictasia.[2][3]
Genetics
The pathogenesis of hepatocellular adenoma usually involves the Wnt signalling pathway.
Gross Pathology
- On gross pathological appearance, the hepatocellular adenoma is a solitary or multiple, un encapsulated and well demarcated mass lesion, which can occasionally be pedunculated or encapsulated, which can also form multiple masses.[4][5]
- The mass has a soft and fleshy consistency and size ranges from 1 to 30 cm.
- The cut surface may be solid tan or yellow depending upon the presence or absence of steatosis.
- The intratumoral hemorrhage can give rise to a soft, necrotic, red brown lesion.
- Tumor hepatocytes have cytoplasm that may be normal, clear (glycogen rich), steatotic or contain pigment in the lysosomes. Nuclear atypia and mitosis are unusual but may be seen in specific variants.[6][7]
Microscopic Pathology
- The microscopic features of hepatocellular adenoma include benign hepatocytes arranged in mildly thickened cell plates, with a preserved reticulin network and thin walled arteries.[4]
- The arteries and arterioles are not accompanied by other portal tract elements such as bile ducts, portal veins or fibroconnective tissue.
- Other variable features include; the presence of steatosis, inflammatory cell infiltrates, dystrophic blood vessels, ductular reaction, sinusoidal dilatation, hemorhage and peliosis.[8][9]
-
![Low magnification micrograph of a hepatic adenoma. H&E stain.[10]](/images/9/90/Hepatic_adenoma_low_magnification.jpg)
Low magnification micrograph of a hepatic adenoma. H&E stain.[10]
-
![High magnification micrograph of a hepatic adenoma. H&E stain.[11]](/images/4/42/Hepatocellular_adenoma_high_magnification.jpg)
High magnification micrograph of a hepatic adenoma. H&E stain.[11]
![Low magnification micrograph of a hepatic adenoma. H&E stain.[10]](/index.php/File:Hepatic_adenoma_low_magnification.jpg)
![High magnification micrograph of a hepatic adenoma. H&E stain.[11]](/index.php/File:Hepatocellular_adenoma_high_magnification.jpg)
References
- ↑ J. K. Baum, J. J. Bookstein, F. Holtz & E. W. Klein (1973). "Possible association between benign hepatomas and oral contraceptives". Lancet (London, England). 2 (7835): 926–929. PMID 4126557. Unknown parameter
|month=ignored (help) - ↑ Khan, MuhammadRizwan; Begum, Saleema (2018). "Hepatocellular adenoma: Review of contemporary diagnostic and therapeutic options". IJS Short Reports. 3 (1): 1. doi:10.4103/ijssr.ijssr_4_18. ISSN 2468-7332.
- ↑ Védie, Anne-Laure; Sutter, Olivier; Ziol, Marianne; Nault, Jean-Charles (2018). "Molecular classification of hepatocellular adenomas: impact on clinical practice". Hepatic Oncology. 5 (1): HEP04. doi:10.2217/hep-2017-0023. ISSN 2045-0923.
- ↑ 4.0 4.1 Barthelmes L, Tait IS (2005). "Liver cell adenoma and liver cell adenomatosis". HPB (Oxford). 7 (3): 186–96. doi:10.1080/13651820510028954. PMC 2023950. PMID 18333188.
- ↑ Grazioli L, Federle MP, Brancatelli G, Ichikawa T, Olivetti L, Blachar A (2001). "Hepatic adenomas: imaging and pathologic findings". Radiographics. 21 (4): 877–92, discussion 892-4. doi:10.1148/radiographics.21.4.g01jl04877. PMID 11452062.
- ↑ Nault, Jean-Charles; Paradis, Valérie; Cherqui, Daniel; Vilgrain, Valérie; Zucman-Rossi, Jessica (2017). "Molecular classification of hepatocellular adenoma in clinical practice". Journal of Hepatology. 67 (5): 1074–1083. doi:10.1016/j.jhep.2017.07.009. ISSN 0168-8278.
- ↑ L. M. Franco, V. Krishnamurthy, D. Bali, D. A. Weinstein, P. Arn, B. Clary, A. Boney, J. Sullivan, D. P. Frush, Y.-T. Chen & P. S. Kishnani (2005). "Hepatocellular carcinoma in glycogen storage disease type Ia: a case series". Journal of inherited metabolic disease. 28 (2): 153–162. doi:10.1007/s10545-005-7500-2. PMID 15877204.
- ↑ Dhingra, Sadhna; Fiel, M. Isabel (2014). "Update on the New Classification of Hepatic Adenomas: Clinical, Molecular, and Pathologic Characteristics". Archives of Pathology & Laboratory Medicine. 138 (8): 1090–1097. doi:10.5858/arpa.2013-0183-RA. ISSN 0003-9985.
- ↑ Nault, Jean-Charles; Couchy, Gabrielle; Balabaud, Charles; Morcrette, Guillaume; Caruso, Stefano; Blanc, Jean-Frederic; Bacq, Yannick; Calderaro, Julien; Paradis, Valérie; Ramos, Jeanne; Scoazec, Jean-Yves; Gnemmi, Viviane; Sturm, Nathalie; Guettier, Catherine; Fabre, Monique; Savier, Eric; Chiche, Laurence; Labrune, Philippe; Selves, Janick; Wendum, Dominique; Pilati, Camilla; Laurent, Alexis; De Muret, Anne; Le Bail, Brigitte; Rebouissou, Sandra; Imbeaud, Sandrine; Bioulac-Sage, Paulette; Letouzé, Eric; Zucman-Rossi, Jessica; Laurent, Christophe; Saric, Jean; Frulio, Nora; Castain, Claire; Dujardin, Fanny; Benchellal, Zin; Bourlier, Pascal; Azoulay, Daniel; Luciani, Alain; Pageaux, Georges-Philippe; Fabre, Jean-Michel; Vilgrain, Valerie; Belghiti, Jacques; Bancel, Brigitte; Boleslawski, Emmanuel; Letoublon, Christophe; Vaillant, Jean Christophe; Prévôt, Sophie; Castaing, Denis; Jacquemin, Emmanuel; Peron, Jean Marie; Quaglia, Alberto; Paye, François; Terraciano, Luigi; Mazzaferro, Vincenzo; Saint Paul, Marie Christine; Terris, Benoit (2017). "Molecular Classification of Hepatocellular Adenoma Associates With Risk Factors, Bleeding, and Malignant Transformation". Gastroenterology. 152 (4): 880–894.e6. doi:10.1053/j.gastro.2016.11.042. ISSN 0016-5085.
- ↑ Hepatic adenoma. Librepathology (2015). http://librepathology.org/wiki/index.php/File:Hepatic_adenoma_low_mag.jpg Accessed on November 3, 2015
- ↑ Hepatic adenoma. Librepathology (2015). http://librepathology.org/wiki/index.php/File:Hepatic_adenoma_high_mag.jpg Accessed on November 7, 2015
