Malignant transformation of hepatic adenomas

Shien T L Micchelli, Perumal Vivekanandan, John K. Boitnott, Timothy M. Pawlik, Michael A. Choti, Michael Torbenson

Research output: Contribution to journalArticle

73 Citations (Scopus)

Abstract

Hepatic adenomas are benign neoplasms of the liver that occur in several well-defined clinical settings, but principally that of excess hormone exposure. They have a small but poorly characterized risk of malignant degeneration. The clinical presentation and pathological findings were reviewed for all hepatic adenomas resected between January 1, 2003 and July 1, 2006. Immunohistochemistry for p53, β-catenin and α-fetoprotein (AFP) were performed on those cases with malignant transformation and exon 3 of β-catenin was amplified and sequenced. A total of 17 hepatic adenomas were resected and 3 showed malignant transformation. All three cases were in women with an age range of 23-33 years. The clinical presentations were vague abdominal pain. Histologically, the malignant transformation occurred within otherwise typical hepatic adenomas. Two of three cases showed patchy atypia throughout the hepatic adenoma. The hepatocellular carcinoma arose as distinct nodules directly within the adenomas, effectively ruling out synchronous lesions. The hepatocellular carcinomas were unifocal in two cases and multifocal in one case with the greatest dimensions of the hepatocellular carcinoma being 2.5, 2.2, and 1 cm. Immunostains for AFP and β-catenin were negative in both the hepatic adenomas and areas of hepatocellular carcinoma. p53 immunostaining was positive within the areas of malignant transformation in one case. No mutations or deletions were seen in exon 3 of the β-catenin gene for either the adenomas or the carcinoma. In conclusion, two of the cases that developed hepatocellular carcinomas showed cytological atypia in the background adenoma. The hepatocellular carcinomas arose as distinct nodules within the adenomas. No common molecular pathway of hepatocellular carcinogenesis was observed by examining AFP, β-catenin, and p53 immunostains and no β-catenin mutations or deletions were found.

Original languageEnglish (US)
Pages (from-to)491-497
Number of pages7
JournalModern Pathology
Volume21
Issue number4
DOIs
StatePublished - Apr 2008

Fingerprint

Adenoma
Catenins
Liver
Hepatocellular Carcinoma
Fetal Proteins
Sequence Deletion
Exons
Abdominal Pain
Carcinogenesis
Immunohistochemistry
Hormones
Carcinoma

Keywords

  • β-catenin
  • Hepatic adenoma
  • Hepatocellular carcinoma

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Micchelli, S. T. L., Vivekanandan, P., Boitnott, J. K., Pawlik, T. M., Choti, M. A., & Torbenson, M. (2008). Malignant transformation of hepatic adenomas. Modern Pathology, 21(4), 491-497. https://doi.org/10.1038/modpathol.2008.8

Malignant transformation of hepatic adenomas. / Micchelli, Shien T L; Vivekanandan, Perumal; Boitnott, John K.; Pawlik, Timothy M.; Choti, Michael A.; Torbenson, Michael.

In: Modern Pathology, Vol. 21, No. 4, 04.2008, p. 491-497.

Research output: Contribution to journalArticle

Micchelli, STL, Vivekanandan, P, Boitnott, JK, Pawlik, TM, Choti, MA & Torbenson, M 2008, 'Malignant transformation of hepatic adenomas', Modern Pathology, vol. 21, no. 4, pp. 491-497. https://doi.org/10.1038/modpathol.2008.8
Micchelli STL, Vivekanandan P, Boitnott JK, Pawlik TM, Choti MA, Torbenson M. Malignant transformation of hepatic adenomas. Modern Pathology. 2008 Apr;21(4):491-497. https://doi.org/10.1038/modpathol.2008.8
Micchelli, Shien T L ; Vivekanandan, Perumal ; Boitnott, John K. ; Pawlik, Timothy M. ; Choti, Michael A. ; Torbenson, Michael. / Malignant transformation of hepatic adenomas. In: Modern Pathology. 2008 ; Vol. 21, No. 4. pp. 491-497.
@article{b706a56eda11486fb7a071e45f74b053,
title = "Malignant transformation of hepatic adenomas",
abstract = "Hepatic adenomas are benign neoplasms of the liver that occur in several well-defined clinical settings, but principally that of excess hormone exposure. They have a small but poorly characterized risk of malignant degeneration. The clinical presentation and pathological findings were reviewed for all hepatic adenomas resected between January 1, 2003 and July 1, 2006. Immunohistochemistry for p53, β-catenin and α-fetoprotein (AFP) were performed on those cases with malignant transformation and exon 3 of β-catenin was amplified and sequenced. A total of 17 hepatic adenomas were resected and 3 showed malignant transformation. All three cases were in women with an age range of 23-33 years. The clinical presentations were vague abdominal pain. Histologically, the malignant transformation occurred within otherwise typical hepatic adenomas. Two of three cases showed patchy atypia throughout the hepatic adenoma. The hepatocellular carcinoma arose as distinct nodules directly within the adenomas, effectively ruling out synchronous lesions. The hepatocellular carcinomas were unifocal in two cases and multifocal in one case with the greatest dimensions of the hepatocellular carcinoma being 2.5, 2.2, and 1 cm. Immunostains for AFP and β-catenin were negative in both the hepatic adenomas and areas of hepatocellular carcinoma. p53 immunostaining was positive within the areas of malignant transformation in one case. No mutations or deletions were seen in exon 3 of the β-catenin gene for either the adenomas or the carcinoma. In conclusion, two of the cases that developed hepatocellular carcinomas showed cytological atypia in the background adenoma. The hepatocellular carcinomas arose as distinct nodules within the adenomas. No common molecular pathway of hepatocellular carcinogenesis was observed by examining AFP, β-catenin, and p53 immunostains and no β-catenin mutations or deletions were found.",
keywords = "β-catenin, Hepatic adenoma, Hepatocellular carcinoma",
author = "Micchelli, {Shien T L} and Perumal Vivekanandan and Boitnott, {John K.} and Pawlik, {Timothy M.} and Choti, {Michael A.} and Michael Torbenson",
year = "2008",
month = "4",
doi = "10.1038/modpathol.2008.8",
language = "English (US)",
volume = "21",
pages = "491--497",
journal = "Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc",
issn = "0893-3952",
publisher = "Nature Publishing Group",
number = "4",

}

TY - JOUR

T1 - Malignant transformation of hepatic adenomas

AU - Micchelli, Shien T L

AU - Vivekanandan, Perumal

AU - Boitnott, John K.

AU - Pawlik, Timothy M.

AU - Choti, Michael A.

AU - Torbenson, Michael

PY - 2008/4

Y1 - 2008/4

N2 - Hepatic adenomas are benign neoplasms of the liver that occur in several well-defined clinical settings, but principally that of excess hormone exposure. They have a small but poorly characterized risk of malignant degeneration. The clinical presentation and pathological findings were reviewed for all hepatic adenomas resected between January 1, 2003 and July 1, 2006. Immunohistochemistry for p53, β-catenin and α-fetoprotein (AFP) were performed on those cases with malignant transformation and exon 3 of β-catenin was amplified and sequenced. A total of 17 hepatic adenomas were resected and 3 showed malignant transformation. All three cases were in women with an age range of 23-33 years. The clinical presentations were vague abdominal pain. Histologically, the malignant transformation occurred within otherwise typical hepatic adenomas. Two of three cases showed patchy atypia throughout the hepatic adenoma. The hepatocellular carcinoma arose as distinct nodules directly within the adenomas, effectively ruling out synchronous lesions. The hepatocellular carcinomas were unifocal in two cases and multifocal in one case with the greatest dimensions of the hepatocellular carcinoma being 2.5, 2.2, and 1 cm. Immunostains for AFP and β-catenin were negative in both the hepatic adenomas and areas of hepatocellular carcinoma. p53 immunostaining was positive within the areas of malignant transformation in one case. No mutations or deletions were seen in exon 3 of the β-catenin gene for either the adenomas or the carcinoma. In conclusion, two of the cases that developed hepatocellular carcinomas showed cytological atypia in the background adenoma. The hepatocellular carcinomas arose as distinct nodules within the adenomas. No common molecular pathway of hepatocellular carcinogenesis was observed by examining AFP, β-catenin, and p53 immunostains and no β-catenin mutations or deletions were found.

AB - Hepatic adenomas are benign neoplasms of the liver that occur in several well-defined clinical settings, but principally that of excess hormone exposure. They have a small but poorly characterized risk of malignant degeneration. The clinical presentation and pathological findings were reviewed for all hepatic adenomas resected between January 1, 2003 and July 1, 2006. Immunohistochemistry for p53, β-catenin and α-fetoprotein (AFP) were performed on those cases with malignant transformation and exon 3 of β-catenin was amplified and sequenced. A total of 17 hepatic adenomas were resected and 3 showed malignant transformation. All three cases were in women with an age range of 23-33 years. The clinical presentations were vague abdominal pain. Histologically, the malignant transformation occurred within otherwise typical hepatic adenomas. Two of three cases showed patchy atypia throughout the hepatic adenoma. The hepatocellular carcinoma arose as distinct nodules directly within the adenomas, effectively ruling out synchronous lesions. The hepatocellular carcinomas were unifocal in two cases and multifocal in one case with the greatest dimensions of the hepatocellular carcinoma being 2.5, 2.2, and 1 cm. Immunostains for AFP and β-catenin were negative in both the hepatic adenomas and areas of hepatocellular carcinoma. p53 immunostaining was positive within the areas of malignant transformation in one case. No mutations or deletions were seen in exon 3 of the β-catenin gene for either the adenomas or the carcinoma. In conclusion, two of the cases that developed hepatocellular carcinomas showed cytological atypia in the background adenoma. The hepatocellular carcinomas arose as distinct nodules within the adenomas. No common molecular pathway of hepatocellular carcinogenesis was observed by examining AFP, β-catenin, and p53 immunostains and no β-catenin mutations or deletions were found.

KW - β-catenin

KW - Hepatic adenoma

KW - Hepatocellular carcinoma

UR - http://www.scopus.com/inward/record.url?scp=41149098221&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=41149098221&partnerID=8YFLogxK

U2 - 10.1038/modpathol.2008.8

DO - 10.1038/modpathol.2008.8

M3 - Article

VL - 21

SP - 491

EP - 497

JO - Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc

JF - Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc

SN - 0893-3952

IS - 4

ER -