Campos Elisabete, Silva Roberto, Rodrigues Sara, de Almeida Marinho, Lopes Joanne, Aral Marisa, Cristino Humberto, Graça Luís, Barbosa Elisabete
Hepato-Bilio-Pancreatic and Splenic Unit, General Surgery Department, São João University Medical Center, Oporto, Portugal.
Pathology Department, São João University Medical Center, Oporto, Portugal.
Case Rep Surg. 2023 Mar 29;2023:2831510. doi: 10.1155/2023/2831510. eCollection 2023.
Hepatocellular adenoma (HCA) is an uncommon solid, solitary, benign liver lesion that develops in an otherwise normal-appearing liver. Hemorrhage and malignant transformation are the most important complications. Risk factors for malignant transformation include advanced age, male gender, use of anabolic steroids, metabolic syndrome, larger lesions, and beta-catenin activation subtype. The identification of higher risk adenomas enables the selection of patients most suitable for aggressive treatment and those who benefit with surveillance, minimizing the risks for these predominantly young patients. . We present the case of a 29-year-old woman with a history of oral contraceptive intake for 13 years, which was sent to evaluation in our Hepato-Bilio-Pancreatic and Splenic Unit because of a large nodular lesion in segment 5 of the liver, compatible with HCA, and was proposed to surgical resection. Histological and immunohistochemical investigation revealed an area with atypical characteristics, suggesting malignant transformation.
HCAs share similar imaging characteristics and histopathological features with hepatocellular carcinomas; therefore, immunohistochemical and genetic studies assumes great importance to discriminate adenomas with malignant transformation. Beta-catenin, glutamine synthetase, glypican-3, and heat-shock protein 70 are promising markers to identify higher risk adenomas.
肝细胞腺瘤（HCA）是一种罕见的实性、孤立性良性肝脏病变，发生于外观正常的肝脏。出血和恶变是最重要的并发症。恶变的危险因素包括高龄、男性、使用合成代谢类固醇、代谢综合征、较大的病变以及β-连环蛋白激活亚型。识别高风险腺瘤有助于选择最适合积极治疗的患者以及适合进行监测的患者，从而将这些主要为年轻患者的风险降至最低。我们报告一例29岁女性病例，该患者有13年口服避孕药史，因肝脏第5段出现一个与HCA相符的大结节性病变，被送至我们的肝胆胰脾科进行评估，并建议手术切除。组织学和免疫组化检查发现一个具有非典型特征的区域，提示恶变。
HCA与肝细胞癌具有相似的影像学特征和组织病理学特征；因此，免疫组化和基因研究对于鉴别恶变腺瘤非常重要。β-连环蛋白、谷氨酰胺合成酶、磷脂酰肌醇蛋白聚糖-3和热休克蛋白70是识别高风险腺瘤的有前景的标志物。
