Department of Pathology, Erciyes University, Kayseri, Turkey.
Department of Pathology, University of California San Francisco, San Francisco, CA, USA.
Histopathology. 2021 Jul;79(1):23-33. doi: 10.1111/his.14330. Epub 2021 Apr 12.
Hepatocellular adenoma (HCA) is an uncommon liver neoplasm, and studies of HCA subtypes have been primarily limited to France, the USA, and Japan. The aim of this study was to describe the clinicopathological features of HCA subtypes in Turkey.
The resection specimens of 59 cases diagnosed as 'hepatocellular adenoma' collected from 15 institutions were reviewed to confirm the diagnosis and to classify them according to the current World Health Organization 2019 classification. Immunostaining for glutamine synthetase, liver fatty acid-binding protein, C-reactive protein, β-catenin and reticulin was performed. Of the 59 cases, 48 (81%) were diagnosed as HCA. We identified 24 (50%) hepatocyte nuclear factor 1α (HNF1α)-inactivated HCAs, five (10%) inflammatory HCAs, 15 (32%) β-catenin-activated HCAs, three (6%) β-catenin-activated inflammatory HCAs, and one (2%) unclassified HCA. HCA patients were predominantly female (female/male ratio of 5:1); they had a median age of 34 years and a median tumour diameter of 60 mm. In the β-catenin-activated HCA group, nine cases (19%) showed cytoarchitectural atypia, and were also referred to as atypical hepatocellular neoplasms. In the β-catenin-activated HCA group, three cases (6%) showed focal areas supportive of transition to HCA. The original diagnosis of HCA was changed to well-differentiated hepatocellular carcinoma in nine cases and to focal nodular hyperplasia in two cases.
In our series, the major HCA subtype was HNF1α-inactivated HCA. We found a low incidence of inflammatory-type HCA. Our data also showed that β-catenin-activated hepatocellular neoplasms, including cases with atypical histology, constituted a relatively high proportion of the cases. These findings are in contrast to those of most other studies of HCA subtypes.
肝细胞腺瘤（HCA）是一种罕见的肝脏肿瘤，对 HCA 亚型的研究主要局限于法国、美国和日本。本研究旨在描述土耳其 HCA 亚型的临床病理特征。
从 15 个机构收集了 59 例诊断为“肝细胞腺瘤”的切除标本进行复查，以确认诊断，并根据 2019 年世界卫生组织的分类对其进行分类。进行了谷氨酰胺合成酶、肝脂肪酸结合蛋白、C 反应蛋白、β-连环蛋白和网状蛋白的免疫染色。在 59 例病例中，48 例（81%）被诊断为 HCA。我们发现 24 例（50%）肝细胞核因子 1α（HNF1α）失活的 HCA、5 例（10%）炎症性 HCA、15 例（32%）β-连环蛋白激活的 HCA、3 例（6%）β-连环蛋白激活的炎症性 HCA和 1 例（2%）未分类的 HCA。HCA 患者主要为女性（女/男比例为 5:1）；中位年龄为 34 岁，中位肿瘤直径为 60mm。在β-连环蛋白激活的 HCA 组中，9 例（19%）出现了细胞结构异型性，也被称为非典型肝细胞肿瘤。在β-连环蛋白激活的 HCA 组中，有 3 例（6%）出现了支持向 HCA 转化的局灶性区域。9 例原诊断为 HCA 的病例被改为分化良好的肝细胞癌，2 例改为局灶性结节性增生。
在我们的系列中，主要的 HCA 亚型是 HNF1α 失活的 HCA。我们发现炎症型 HCA 的发病率较低。我们的数据还显示，β-连环蛋白激活的肝细胞肿瘤，包括具有非典型组织学特征的病例，构成了较高比例的病例。这些发现与大多数其他 HCA 亚型的研究结果不同。
