Hepatocellular adenoma classification
|
Hepatocellular adenoma Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Hepatocellular adenoma classification On the Web |
|
American Roentgen Ray Society Images of Hepatocellular adenoma classification |
|
Risk calculators and risk factors for Hepatocellular adenoma classification |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zahir Ali Shaikh, MD[2]
Overview
Classification
- In 2007, Bioulac-sage and associates from bordeaux classified the hepatocellular adenomas based on molecular patterns called phenotypic-genotypic classification. They classified heaptocellular adenomas into 04 main groups.[1][2]
| Hepatocellular Adenoma | |||||||||||||||||||||||||||||||||||||||||||
| HNF-1 alpha inactivated adenoma | Beta catenin activated adenoma | Inflammatory hepatic adenoma | Unclassified type adenoma | ||||||||||||||||||||||||||||||||||||||||
- HNF-1 alpha inactivated hepatocellular adenoma (35-40%)
- This group of hepatocellular adenomas is defined by the somatic inactivation of HNF1A (hepatocyte nuclear factor 1 A) gene, by a mutational mechanism in tumor cells.[3]
- HNF1A is a transcription factor controlling hepatocyte metabolism.[4]
- Most of these variants show macrovesicular steatosis of variable extent and no atypical hepatocytes and are associated to metabolic syndrome.
- This type occurs mostly in women and is often associated with maturity onset diabetes of young (MODY3).
- Expression of liver fatty acid binding protein (LFABP) involved in lipid trafficking, usually expressed in normal liver, is specifically downregulated in these cases as a consequence of HNF1A mutation.
- Inflammatory hepatocellular adenoma (40-50%)
- The most important feature of these tumors is activation of JAk/STAT pathway.[5]
- Inflammatory hepatocellular adenomas also exhibit over expression of serum amyloid alpha (SAA) and C-reactive protein (CRP) induced by STAT3.
- They show greater morphological pleomorphism as they may show pseudo portal tracts, sinusoidal dilatation, dystrophic arteries, hemorrhage and inflammatory infiltrate.
- Inflammatory syndrome, obesity and alcohol consumption are reported in these patients.
- Five different molecular drivers, IL6 signal transducer, FRK, STAT3, GNAS and JAK1 have been reported.[6]
- Beta catenin mutated hepatocellular adenoma (10-15%)
- These are frequently associated with exposure to male hormones, glycogenolysis and familial adenomatous polyposis.[7]
- This group has a higher risk of malignant potential.[8]
- Morphologically these tumors have cytoogical and architectural atypical features of tumoral hepatocytes and cholestasis as well.
- On immunohistochemical staining, these adenomas tend to stain for glutamine synthetase rather than beta catenin, which stains patchily.
- Unclassified hepatocellular adenoma (10%)
- By definition, they lack characteristics of other subtypes and their identification rlies on a silent phenotype and by exclusion of criteria featuring other subtypes.
- Until now their pathogenesis remains unidentified.
- These adenomas do not stain for the C-reactive protein (CRP), beta catenin or glutamine synthetase.[9]
References
- ↑ Kun Jiang, Sameer Al-Diffhala & Barbara A. Centeno (2018). "Primary Liver Cancers-Part 1: Histopathology, Differential Diagnoses, and Risk Stratification". Cancer control : journal of the Moffitt Cancer Center. 25 (1): 1073274817744625. doi:10.1177/1073274817744625. PMID 29350068. Unknown parameter
|month=ignored (help) - ↑ H. Dharmana, S. Saravana-Bawan, S. Girgis & G. Low (2017). "Hepatocellular adenoma: imaging review of the various molecular subtypes". Clinical radiology. 72 (4): 276–285. doi:10.1016/j.crad.2016.12.020. PMID 28126185. Unknown parameter
|month=ignored (help) - ↑ Aparna P.. Shreenath & Arslan Kahloon (2018). "Hepatic (Hepatocellular) Adenoma". PMID 30020636. Unknown parameter
|month=ignored (help) - ↑ Motoko Sasaki, Norihide Yoneda, Seiko Kitamura, Yasunori Sato & Yasuni Nakanuma (2011). "Characterization of hepatocellular adenoma based on the phenotypic classification: The Kanazawa experience". Hepatology research : the official journal of the Japan Society of Hepatology. 41 (10): 982–988. doi:10.1111/j.1872-034X.2011.00851.x. PMID 21883740. Unknown parameter
|month=ignored (help) - ↑ Jean-Charles Nault, Paulette Bioulac-Sage & Jessica Zucman-Rossi (2013). "Hepatocellular benign tumors-from molecular classification to personalized clinical care". Gastroenterology. 144 (5): 888–902. doi:10.1053/j.gastro.2013.02.032. PMID 23485860. Unknown parameter
|month=ignored (help) - ↑ Motoko Sasaki, Norihide Yoneda, Yoshiyuki Sawai, Yasuharu Imai, Fukuo Kondo, Toshio Fukusato, Seiichi Yoshikawa, Satoshi Kobayashi, Yasunori Sato, Osamu Matsui & Yasuni Nakanuma (2015). "Clinicopathological characteristics of serum amyloid A-positive hepatocellular neoplasms/nodules arising in alcoholic cirrhosis". Histopathology. 66 (6): 836–845. doi:10.1111/his.12588. PMID 25318388. Unknown parameter
|month=ignored (help) - ↑ Kimberley J. Evason, James P. Grenert, Linda D. Ferrell & Sanjay Kakar (2013). "Atypical hepatocellular adenoma-like neoplasms with beta-catenin activation show cytogenetic alterations similar to well-differentiated hepatocellular carcinomas". Human pathology. 44 (5): 750–758. doi:10.1016/j.humpath.2012.07.019. PMID 23084586. Unknown parameter
|month=ignored (help) - ↑ Camilla Pilati, Eric Letouze, Jean-Charles Nault, Sandrine Imbeaud, Anais Boulai, Julien Calderaro, Karine Poussin, Andrea Franconi, Gabrielle Couchy, Guillaume Morcrette, Maxime Mallet, Said Taouji, Charles Balabaud, Benoit Terris, Frederic Canal, Valerie Paradis, Jean-Yves Scoazec, Anne de Muret, Catherine Guettier, Paulette Bioulac-Sage, Eric Chevet, Fabien Calvo & Jessica Zucman-Rossi (2014). "Genomic profiling of hepatocellular adenomas reveals recurrent FRK-activating mutations and the mechanisms of malignant transformation". Cancer cell. 25 (4): 428–441. doi:10.1016/j.ccr.2014.03.005. PMID 24735922. Unknown parameter
|month=ignored (help) - ↑ Paulette Bioulac-Sage, Gaelle Cubel, Said Taouji, Jean-Yves Scoazec, Emmanuelle Leteurtre, Valerie Paradis, Nathalie Sturm, Jeanne Tran Van Nhieu, Dominique Wendum, Brigitte Bancel, Jeanne Ramos, Francois Paraf, Marie Christine Saint Paul, Sophie Michalak, Monique Fabre, Catherine Guettier, Brigitte Le Bail, Jessica Zucman-Rossi & Charles Balabaud (2012). "Immunohistochemical markers on needle biopsies are helpful for the diagnosis of focal nodular hyperplasia and hepatocellular adenoma subtypes". The American journal of surgical pathology. 36 (11): 1691–1699. doi:10.1097/PAS.0b013e3182653ece. PMID 23060349. Unknown parameter
|month=ignored (help)