Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
J Hepatol. 2011 Jul;55(1):120-5. doi: 10.1016/j.jhep.2010.10.030. Epub 2010 Nov 24.
BACKGROUND & AIMS: A molecular and pathological classification system for hepatocellular adenomas (HCA) was recently introduced and four major subgroups were identified. We aimed to validate this adenoma classification system and to determine the clinical relevance of the subtypes for surgical management.
Paraffin fixed liver tissue slides and resection specimens of patients radiologically diagnosed as HCA were retrieved from the department of pathology. Immunostainings included liver-fatty acid binding protein (L-FABP), serum amyloid A (SAA), C-reactive protein (CRP), glutamine synthetase (GS) and β-catenin.
From 2000 to 2010, 58 cases (71 lesions) were surgically resected. Fourteen lesions were diagnosed as focal nodular hyperplasia with a characteristic map-like staining pattern of GS. Inflammatory HCA expressing CRP and SAA was documented in 36 of 57 adenomas (63%). Three of these inflammatory adenomas were also β-catenin positive as well as GS positive and only one was CRP and SAA and GS positive. We identified eleven L-FABP-negative HCA (19%) and four β-catenin positive HCA (7%), without expression of CRP and SAA and with normal L-FABP staining, one of which was also GS positive. Six HCA were unclassifiable (11%). In three patients multiple adenomas of different subtypes were found.
Morphology and additional immunohistochemical markers can discriminate between different types of HCA in>90% of cases and this classification, including the identification of β-catenin positive adenomas may have important implications in the decision for surveillance or treatment. Interpretation of nuclear staining for β-catenin can be difficult due to uneven staining distribution or focal nuclear staining and additional molecular biology may be required.
最近提出了一种用于肝细胞腺瘤(HCA)的分子和病理分类系统,并确定了四个主要亚组。我们旨在验证该腺瘤分类系统,并确定亚型对手术管理的临床相关性。
从病理学系中检索出经影像学诊断为 HCA 的患者的石蜡固定肝组织切片和切除标本。免疫染色包括肝脂肪酸结合蛋白(L-FABP)、血清淀粉样蛋白 A(SAA)、C 反应蛋白(CRP)、谷氨酰胺合成酶(GS)和β-连环蛋白。
在 2000 年至 2010 年间,手术切除了 58 例(71 个病灶)。14 个病灶被诊断为局灶性结节性增生,具有 GS 的特征地图样染色模式。在 57 个腺瘤中有 36 个(63%)被诊断为炎症性 HCA,表达 CRP 和 SAA。其中 3 个炎症性腺瘤也是β-连环蛋白阳性和 GS 阳性,只有 1 个是 CRP、SAA 和 GS 阳性。我们确定了 11 个 L-FABP 阴性 HCA(19%)和 4 个β-连环蛋白阳性 HCA(7%),不表达 CRP 和 SAA,L-FABP 染色正常,其中 1 个也是 GS 阳性。有 6 个 HCA 无法分类(11%)。在 3 名患者中发现了多个不同亚型的腺瘤。
形态学和其他免疫组织化学标志物可在>90%的病例中区分不同类型的 HCA,这种分类,包括识别β-连环蛋白阳性腺瘤,可能对监测或治疗决策具有重要意义。由于不均匀染色分布或局灶性核染色,核染色β-连环蛋白的解读可能很困难,可能需要额外的分子生物学。