Hepatocellular adenoma (HCA) is a rare benign liver tumour associated with the use of oral contraceptives or other steroid medications which occurs predominantly in young and middle-aged women. Unlike other benign liv...Hepatocellular adenoma (HCA) is a rare benign liver tumour associated with the use of oral contraceptives or other steroid medications which occurs predominantly in young and middle-aged women. Unlike other benign liver tumours, an HCA may be complicated by bleeding and malignant transformation. HCAs have been divided into four subtypes based on molecular and pathological features: hepatocyte nuclear factor 1α-mutated HCA, inflammatory HCA,β-catenin-mutated HCA, and unclassified HCA.β-cateninmutated HCA has the highest risk of haemorrhage or malignant transformation. In the latest upgrade of the guidelines regarding the management of benign liver tumours published in 2016 by the European Association for the Study of the Liver, magnetic resonance imaging (MRI) was recognized to be superior to all other imaging modalities in detecting HCAs and in being able to subtype HCAs up to 80%, with positive identification of 1α-mutated HCA or inflammatory HCA achievable with > 90% specificity. This review analyzed the imaging features of HCA using MRI with hepato-specific contrast agents, focusing on the limitations in the HCA characterization.展开更多
BACKGROUNI）： Hepatocellular adenoma （HCA） is a rare benign tumor of the liver. It is of clinical importance to dif- ferentiate HCA from other liver tumors, especially hepatocel- lular carcinoma （HCC）. This study...BACKGROUNI）： Hepatocellular adenoma （HCA） is a rare benign tumor of the liver. It is of clinical importance to dif- ferentiate HCA from other liver tumors, especially hepatocel- lular carcinoma （HCC）. This study aimed to evaluate the char- acteristic features of HCA by conventional ultrasound and contrast-enhanced ultrasound （CEUS） findings. METHODS： Twenty-six patients （10 males and 16 females; mean age 36.2＋5.0 years） with 26 histopathologically proven HCAs were retrospectively identified. According to the maxi- mum diameter of HCAs, they were divided into three groups： 〈30 mm, 30-50 mm, and 〉50 mm. Ultrasound examinations were performed with C5-2 broadband curved transducer of Philips iU22 unit （Philips Bothell, WA, USA）. For each lesion, a dose of 2.4 mL SonoVue~ （Bracco Imaging Spa, Milan, Italy） was injected as a quick bolus into the cubital vein. Lesions＇ echogenicity, color-Doppler flow imaging and contrast en- hancement patterns were recorded. RESULTS： Grayscale ultrasound revealed that most of HCAs were hypoechoic （73.1%, 19/26）. Spotty calcifications were detected in 26.9% （7/26） of the lesions. Color-Doppler flow imaging detected centripetal bulky color flow in 46.2% （12/26） of the HCAs. CEUS showed that 73.1% （19/26） of the HCAs displayed as rapid, complete and homogenous enhancement, and 53.8% （14/26） showed decreased contrast enhancement in the late phase. There was no significant difference in enhance- ment patterns among different sizes of HCAs （P〉0.05）. Centripetal enhancement with subcapsular tortuous arteries was common in larger HCAs.展开更多
Hepatocellular adenoma(HCA) was recently classified into four pathological subtypes. There have been few studies describing the findings of contrast-enhanced ultrasonography(CEUS) of each type. Our case concerns a 78-...Hepatocellular adenoma(HCA) was recently classified into four pathological subtypes. There have been few studies describing the findings of contrast-enhanced ultrasonography(CEUS) of each type. Our case concerns a 78-year-old man who had undergone routine medical check-ups for hepatitis C for 11 years. Abdominal ultrasonography showed a 28 mm, hypo-echoic mass in the segment 4 of the liver. His integrating amount of drinking was 670 kg convert into ethanol. CEUS with Sonazoid demonstrated mild uniform hypo-enhancement with inflow of microbubbles from the periphery of the tumor in the arterial phase, and heterogeneously hypo-enhancement in the post vascular phase. Because the mass increased in size within 3 mo, a well differentiated hepatocellular carcinoma was suspected, and hepatic resection was performed. Microscopic findings showed homogeneous cell proliferation with low grade atypia, infiltration of inflammatory cells, ductular reactions, fatty deposit in part, and sinusoidal dilation. Immunohistochemistry revealed geographic positive for serum amyloid A(SAA), focal positive for glutaminesynthetase, diffuse and strong positive for C-reactive protein, and positive for liver-type fatty acid binding protein. These pathological features corresponded to that of an inflammatory HCA. However, we could not make a clear diagnosis, because HCAs were defined as not to arise in cirrhotic liver. Finally, this tumor was diagnosed as a SAA positive hepatocellular neoplasm.展开更多
Immunohistochemistry often plays an important role in the evaluation of liver tumors. Recent advances have established a classification system for hepatocellular adenomas(HCAs) based on morphology,molecular alteration...Immunohistochemistry often plays an important role in the evaluation of liver tumors. Recent advances have established a classification system for hepatocellular adenomas(HCAs) based on morphology,molecular alterations,and immunohistochemistry. Specifically,loss of liver fatty acid binding protein is seen in HNF1α-inactivated HCA,staining with serum amyloid A isseen in inflammatory HCA,and diffuse staining with glutamine synthetase(GS) is seen in β-catenin activated HCA. A panel of immunohistochemical stains including glypican-3(GPC-3),heat shock protein 70,and GS are useful in distinguishing HCC from non-malignant dysplastic nodules. Immunohistochemistry is also useful to determine whether a liver tumor is of primary hepatocellular or metastatic origin. Recently described markers useful for this purpose include arginase-1,GPC-3,and bile salt export pump. These newer markers may offer superior utility when compared to traditional markers of hepatocellular differentiation such as alpha-fetoprotein,hepatocyte paraffin-1,polyclonal carcinoembryonic antigen,and CD10. This paper will review recent advances in the immunohistochemical evaluation of liver tumors.展开更多
This practical atlas aims to help liver and non liver pa-thologists to recognize benign hepatocellular nodules on resected specimen. Macroscopic and microscopic views together with immunohistochemical stains illustrat...This practical atlas aims to help liver and non liver pa-thologists to recognize benign hepatocellular nodules on resected specimen. Macroscopic and microscopic views together with immunohistochemical stains illustrate typical and atypical aspects of focal nodular hyperplasia and of hepatocellular adenoma, including hepatocel-lular adenomas subtypes with references to clinical and imaging data. Each step is important to make a correct diagnosis. The specimen including the nodule and the non-tumoral liver should be sliced, photographed and all different looking areas adequately sampled for par-affin inclusion. Routine histology includes HE, trichrome and cytokeratin 7. Immunohistochemistry includes glu-tamine synthase and according to the above results ad-ditional markers such as liver fatty acid binding protein, C reactive protein and beta catenin may be realized to differentiate focal nodular hyperplasia from hepatocel-lular adenoma subtypes. Clues for differential diagnosis and pitfalls are explained and illustrated.展开更多
Positron emission tomography (PET) using 18F-fluorodeoxyglucose ( 18F-FDG) is an imaging modality which reflects cellular glucose metabolism. Most malignant cells accumulate and trap 18F-FDG, allowing the visualisatio...Positron emission tomography (PET) using 18F-fluorodeoxyglucose ( 18F-FDG) is an imaging modality which reflects cellular glucose metabolism. Most malignant cells accumulate and trap 18F-FDG, allowing the visualisation of increased uptake. It is hence widely used to differentiate malignant from benign lesions. "False positive" findings of hepatic lesions have been described in certain instances such as hepatic abscesses, but are rare in cases involving hepatocellular adenomas. To our knowledge, there have been only 7 reports in the English literature documenting PET-avid hepatocellular adenomas; 6 of the 7 reports were published in the last 3 years with the first report by Patel et al. We report the case of a 44-year-old Chinese female patient with a history of cervical adenocarcinoma, referred for a hepatic lesion noted on a surveillance computed tomography (CT) scan. A subsequent CT-PET performed showed a hypermetabolic lesion (standardized uptake value 7.9) in segment Ⅳb of the liver. After discussion at a multidisciplinary hepato-pancreato-biliary conference, the consensus was that of a metastatic lesion from her previous cervical adenocarcinoma, and a resection of the hepatic lesion was performed. Histology revealed features consistent with a hepatocyte nuclear factor-1 α inactivated steatotic hepatocellular adenoma.展开更多
AIM:To investigate the role of laparoscopy in the surgical management of hepatocellular adenoma(HA). METHODS:We reviewed a prospectively collected database of consecutive patients undergoing laparoscopic liver resecti...AIM:To investigate the role of laparoscopy in the surgical management of hepatocellular adenoma(HA). METHODS:We reviewed a prospectively collected database of consecutive patients undergoing laparoscopic liver resection for HA. RESULTS:Thirteen patients underwent fifteen pure laparoscopic liver resections for HA(male/female:3/10; median age 42 years,range 22-72 years).Two patients with liver adenomatosis required two different laparoscopic operations for ruptured adenomas.Indications for surgery were:symptoms in 12 cases,need to rule out malignancy in 2 cases and preoperative diagnosis of large HA in one case.Symptoms were related to bleeding in 10 cases,sepsis due to liver abscess following embolization of HA in one case and mass effect in one case(shoulder tip pain).Five cases with ruptured bleeding adenoma required emergency admis-sion and treatment with selective arterial embolization. Laparoscopic liver resection was then semi-electively performed.Eight patients(62%)required major hepatectomy[right hepatectomy(n=5),left hepatectomy (n=3)].No conversion to open surgery occurred.The median operative time for pure laparoscopic procedures was 270 min(range 135-360 min).The median size of the excised lesions was 85 mm(range 25-180 mm). One patient with adenomatosis developed postoperative bleeding requiring embolization.Mortality was nil. The median hospital stay was 4 d(range 1-18 d)with a median high dependency unit stay of 1 d(range 0-7 d). CONCLUSION:The laparoscopic approach represents a safe option for the management of HA in a semi-elective setting and when major hepatectomy is required.展开更多
文摘Hepatocellular adenoma (HCA) is a rare benign liver tumour associated with the use of oral contraceptives or other steroid medications which occurs predominantly in young and middle-aged women. Unlike other benign liver tumours, an HCA may be complicated by bleeding and malignant transformation. HCAs have been divided into four subtypes based on molecular and pathological features: hepatocyte nuclear factor 1α-mutated HCA, inflammatory HCA,β-catenin-mutated HCA, and unclassified HCA.β-cateninmutated HCA has the highest risk of haemorrhage or malignant transformation. In the latest upgrade of the guidelines regarding the management of benign liver tumours published in 2016 by the European Association for the Study of the Liver, magnetic resonance imaging (MRI) was recognized to be superior to all other imaging modalities in detecting HCAs and in being able to subtype HCAs up to 80%, with positive identification of 1α-mutated HCA or inflammatory HCA achievable with > 90% specificity. This review analyzed the imaging features of HCA using MRI with hepato-specific contrast agents, focusing on the limitations in the HCA characterization.
基金supported by a grant from the National Natural Science Foundation of China(81371577)
文摘BACKGROUNI）： Hepatocellular adenoma （HCA） is a rare benign tumor of the liver. It is of clinical importance to dif- ferentiate HCA from other liver tumors, especially hepatocel- lular carcinoma （HCC）. This study aimed to evaluate the char- acteristic features of HCA by conventional ultrasound and contrast-enhanced ultrasound （CEUS） findings. METHODS： Twenty-six patients （10 males and 16 females; mean age 36.2＋5.0 years） with 26 histopathologically proven HCAs were retrospectively identified. According to the maxi- mum diameter of HCAs, they were divided into three groups： 〈30 mm, 30-50 mm, and 〉50 mm. Ultrasound examinations were performed with C5-2 broadband curved transducer of Philips iU22 unit （Philips Bothell, WA, USA）. For each lesion, a dose of 2.4 mL SonoVue~ （Bracco Imaging Spa, Milan, Italy） was injected as a quick bolus into the cubital vein. Lesions＇ echogenicity, color-Doppler flow imaging and contrast en- hancement patterns were recorded. RESULTS： Grayscale ultrasound revealed that most of HCAs were hypoechoic （73.1%, 19/26）. Spotty calcifications were detected in 26.9% （7/26） of the lesions. Color-Doppler flow imaging detected centripetal bulky color flow in 46.2% （12/26） of the HCAs. CEUS showed that 73.1% （19/26） of the HCAs displayed as rapid, complete and homogenous enhancement, and 53.8% （14/26） showed decreased contrast enhancement in the late phase. There was no significant difference in enhance- ment patterns among different sizes of HCAs （P〉0.05）. Centripetal enhancement with subcapsular tortuous arteries was common in larger HCAs.
文摘Hepatocellular adenoma(HCA) was recently classified into four pathological subtypes. There have been few studies describing the findings of contrast-enhanced ultrasonography(CEUS) of each type. Our case concerns a 78-year-old man who had undergone routine medical check-ups for hepatitis C for 11 years. Abdominal ultrasonography showed a 28 mm, hypo-echoic mass in the segment 4 of the liver. His integrating amount of drinking was 670 kg convert into ethanol. CEUS with Sonazoid demonstrated mild uniform hypo-enhancement with inflow of microbubbles from the periphery of the tumor in the arterial phase, and heterogeneously hypo-enhancement in the post vascular phase. Because the mass increased in size within 3 mo, a well differentiated hepatocellular carcinoma was suspected, and hepatic resection was performed. Microscopic findings showed homogeneous cell proliferation with low grade atypia, infiltration of inflammatory cells, ductular reactions, fatty deposit in part, and sinusoidal dilation. Immunohistochemistry revealed geographic positive for serum amyloid A(SAA), focal positive for glutaminesynthetase, diffuse and strong positive for C-reactive protein, and positive for liver-type fatty acid binding protein. These pathological features corresponded to that of an inflammatory HCA. However, we could not make a clear diagnosis, because HCAs were defined as not to arise in cirrhotic liver. Finally, this tumor was diagnosed as a SAA positive hepatocellular neoplasm.
文摘Immunohistochemistry often plays an important role in the evaluation of liver tumors. Recent advances have established a classification system for hepatocellular adenomas(HCAs) based on morphology,molecular alterations,and immunohistochemistry. Specifically,loss of liver fatty acid binding protein is seen in HNF1α-inactivated HCA,staining with serum amyloid A isseen in inflammatory HCA,and diffuse staining with glutamine synthetase(GS) is seen in β-catenin activated HCA. A panel of immunohistochemical stains including glypican-3(GPC-3),heat shock protein 70,and GS are useful in distinguishing HCC from non-malignant dysplastic nodules. Immunohistochemistry is also useful to determine whether a liver tumor is of primary hepatocellular or metastatic origin. Recently described markers useful for this purpose include arginase-1,GPC-3,and bile salt export pump. These newer markers may offer superior utility when compared to traditional markers of hepatocellular differentiation such as alpha-fetoprotein,hepatocyte paraffin-1,polyclonal carcinoembryonic antigen,and CD10. This paper will review recent advances in the immunohistochemical evaluation of liver tumors.
基金Supported by Association pour la Recherche sur le Cancer,No.3194
文摘This practical atlas aims to help liver and non liver pa-thologists to recognize benign hepatocellular nodules on resected specimen. Macroscopic and microscopic views together with immunohistochemical stains illustrate typical and atypical aspects of focal nodular hyperplasia and of hepatocellular adenoma, including hepatocel-lular adenomas subtypes with references to clinical and imaging data. Each step is important to make a correct diagnosis. The specimen including the nodule and the non-tumoral liver should be sliced, photographed and all different looking areas adequately sampled for par-affin inclusion. Routine histology includes HE, trichrome and cytokeratin 7. Immunohistochemistry includes glu-tamine synthase and according to the above results ad-ditional markers such as liver fatty acid binding protein, C reactive protein and beta catenin may be realized to differentiate focal nodular hyperplasia from hepatocel-lular adenoma subtypes. Clues for differential diagnosis and pitfalls are explained and illustrated.
文摘Positron emission tomography (PET) using 18F-fluorodeoxyglucose ( 18F-FDG) is an imaging modality which reflects cellular glucose metabolism. Most malignant cells accumulate and trap 18F-FDG, allowing the visualisation of increased uptake. It is hence widely used to differentiate malignant from benign lesions. "False positive" findings of hepatic lesions have been described in certain instances such as hepatic abscesses, but are rare in cases involving hepatocellular adenomas. To our knowledge, there have been only 7 reports in the English literature documenting PET-avid hepatocellular adenomas; 6 of the 7 reports were published in the last 3 years with the first report by Patel et al. We report the case of a 44-year-old Chinese female patient with a history of cervical adenocarcinoma, referred for a hepatic lesion noted on a surveillance computed tomography (CT) scan. A subsequent CT-PET performed showed a hypermetabolic lesion (standardized uptake value 7.9) in segment Ⅳb of the liver. After discussion at a multidisciplinary hepato-pancreato-biliary conference, the consensus was that of a metastatic lesion from her previous cervical adenocarcinoma, and a resection of the hepatic lesion was performed. Histology revealed features consistent with a hepatocyte nuclear factor-1 α inactivated steatotic hepatocellular adenoma.
文摘AIM:To investigate the role of laparoscopy in the surgical management of hepatocellular adenoma(HA). METHODS:We reviewed a prospectively collected database of consecutive patients undergoing laparoscopic liver resection for HA. RESULTS:Thirteen patients underwent fifteen pure laparoscopic liver resections for HA(male/female:3/10; median age 42 years,range 22-72 years).Two patients with liver adenomatosis required two different laparoscopic operations for ruptured adenomas.Indications for surgery were:symptoms in 12 cases,need to rule out malignancy in 2 cases and preoperative diagnosis of large HA in one case.Symptoms were related to bleeding in 10 cases,sepsis due to liver abscess following embolization of HA in one case and mass effect in one case(shoulder tip pain).Five cases with ruptured bleeding adenoma required emergency admis-sion and treatment with selective arterial embolization. Laparoscopic liver resection was then semi-electively performed.Eight patients(62%)required major hepatectomy[right hepatectomy(n=5),left hepatectomy (n=3)].No conversion to open surgery occurred.The median operative time for pure laparoscopic procedures was 270 min(range 135-360 min).The median size of the excised lesions was 85 mm(range 25-180 mm). One patient with adenomatosis developed postoperative bleeding requiring embolization.Mortality was nil. The median hospital stay was 4 d(range 1-18 d)with a median high dependency unit stay of 1 d(range 0-7 d). CONCLUSION:The laparoscopic approach represents a safe option for the management of HA in a semi-elective setting and when major hepatectomy is required.
