Division of Anatomic Pathology, Mayo Clinic, Rochester, MN.
Department of Pathology, Yale University Medical Center, New Haven, CT.
Am J Surg Pathol. 2022 Jun 1;46(6):786-792. doi: 10.1097/PAS.0000000000001892. Epub 2022 Apr 6.
Hepatic adenomas occur most commonly in women between the ages of 20 and 40 years, but rarely they occur in older aged persons, including those 60 years of age or older. This group of adenomas, however, has not been systemically examined. Twenty-six hepatic adenomas in persons 60 years of age or older were studied, along with a control group of 50 hepatic adenomas in persons aged 30 to 39. Hepatic adenomas in persons 60 or more years of age were found in 21 women and 5 men, while the control group had 44 women and 6 men. Subtyping the adenomas in persons 60 years or older showed the following results: 18 HNF1A-inactivated adenomas (69%), 4 inflammatory adenomas (15%), and 4 unclassified adenomas (15%). In contrast, the control group showed a significantly different pattern (P=0.003), with a greater percentage of inflammatory adenomas (28, 56%), fewer HNF1A-inactivated adenomas (8, 16%), and more unclassified adenomas (14, 28%). Atypia and malignant transformation within the hepatic adenomas was studied next. Of the hepatic adenomas in persons age 60 or greater, 3 (12%) showed atypical histologic features, and 6 (23%) had a malignant transformation. In contrast, for hepatic adenomas in the control group, only 4 (8%) adenomas showed atypical histologic features, and 3 (6%) had undergone malignant transformation. In addition, the hepatic adenomas that were atypical or showed early malignant transformation were less likely to have beta-catenin activation in patients over 60 (2/9 cases) compared with those between 30 and 39 years (5/7 cases). Myxoid change and heavy lipofuscin deposition were also more common in adenomas in older aged persons. In conclusion, hepatic adenomas in persons 60 years of age or older are enriched for HNF1A-inactivated adenomas and have a higher frequency of malignant transformation. Malignant transformation, however, is less likely to develop through activation of the beta-catenin pathway.
肝腺瘤最常发生于 20 至 40 岁的女性，但也很少见于年龄较大的人群，包括 60 岁或以上的人群。然而，这组腺瘤并未被系统地研究过。本研究共研究了 26 例 60 岁或以上的肝腺瘤患者，并以 30 至 39 岁的 50 例肝腺瘤患者作为对照组。结果发现，60 岁或以上的患者中有 21 例为女性，5 例为男性；而对照组中有 44 例为女性，6 例为男性。对 60 岁或以上患者的腺瘤进行亚型分析显示：18 例 HNF1A 失活腺瘤（69%），4 例炎症性腺瘤（15%）和 4 例未分类腺瘤（15%）。相比之下，对照组的结果存在显著差异（P=0.003），炎症性腺瘤的比例更高（28%，56%），HNF1A 失活腺瘤的比例更低（8%，16%），未分类腺瘤的比例更高（14%，28%）。接下来研究了肝腺瘤中的异型性和恶性转化。在 60 岁或以上的患者中，3 例（12%）肝腺瘤表现出非典型的组织学特征，6 例（23%）发生了恶性转化。相比之下，对照组的肝腺瘤中，只有 4 例（8%）腺瘤表现出非典型的组织学特征，3 例（6%）发生了恶性转化。此外，在 60 岁以上的患者中，发生异型性或早期恶性转化的肝腺瘤β-catenin 激活的可能性较小（2/9 例），而在 30 至 39 岁的患者中，这一比例为 5/7 例）。黏液样变和大量脂褐素沉积在老年患者的腺瘤中也更为常见。总之，60 岁或以上的肝腺瘤中富含 HNF1A 失活腺瘤，且恶性转化的频率更高。然而，恶性转化不太可能通过β-catenin 通路的激活而发生。
