Envoi Specialist Pathologists, Brisbane, Qld, Australia; Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia.
Envoi Specialist Pathologists, Brisbane, Qld, Australia.
Pathology. 2018 Oct;50(6):593-599. doi: 10.1016/j.pathol.2018.05.003. Epub 2018 Aug 24.
Hepatocellular adenomas are benign liver lesions with a risk of rupture and malignant transformation. Various molecular subgroups have been identified which appear to have characteristic morphological and immunohistochemical features. We examined the morphology and immunohistochemical profile of a series of 121 HCA from 97 patients to identify the HCA subtypes present and determine the number at risk for malignant transformation according to the World Health Organization (WHO) criteria for hepatocellular adenomas. There were 34 HNF1α inactivated HCA (28%), 61 inflammatory HCA (50%), 15 β-catenin activated HCA (12%) and 11 unclassified adenomas (9%). This proportion of cases was similar to that seen in other series utilising molecular classification. The morphological features of the adenomas were suggestive but not definite indicators of the subtypes present. Morphological features that showed overlap between the subtypes included steatosis within the lesion, a ductular reaction and focal atypia, so that immunohistochemical typing was required for accurate classification. In conclusion, immunohistochemistry is a clinically useful surrogate for identifying underlying molecular changes in the HCA subtypes.
肝细胞腺瘤是良性的肝脏病变，有破裂和恶性转化的风险。已经确定了各种分子亚组，它们似乎具有特征性的形态学和免疫组织化学特征。我们检查了 97 例患者的 121 例 HCA 的形态和免疫组织化学特征，以确定存在的 HCA 亚型，并根据世界卫生组织（WHO）肝细胞腺瘤的标准确定发生恶性转化的风险数量。有 34 例 HNF1α 失活的 HCA（28%）、61 例炎症性 HCA（50%）、15 例β-连环蛋白激活的 HCA（12%）和 11 例未分类的腺瘤（9%）。这种利用分子分类的病例比例与其他系列相似。腺瘤的形态特征提示存在某些亚型，但不是明确的指标。在亚型之间存在重叠的形态特征包括病变内的脂肪变性、胆管反应和局灶性异型性，因此需要免疫组织化学分型才能进行准确分类。总之，免疫组织化学是一种用于识别 HCA 亚型潜在分子变化的临床有用替代方法。
