Coelho R, Gonçalves R, Carneiro F, Fernandes M, Lopes J, Guimarães S, Macedo G

Language: English
References: 21
Page: 598-603
PDF size: 208.48 Kb.

ABSTRACT

Hepatocellular adenomas (HCAs) are benign liver tumors recently characterized into 4 different types according to genetic, pathological and clinical features. The prognosis is not well established yet and malignant transformation has been recently associated with β-catenin activation. We aimed to describe a case of a pigmented HCA with β-catenin nuclear expression and inflammatory features and to review the cases of pigmented HCAs in the literature. We report a case of a young female patient without contraceptive use, with a liver tumor diagnosis. Liver biopsy revealed diffuse expression of β-catenin and a partial hepatic resection was performed. The histologic analysis revealed a hepatocellular tumor composed of uniform trabeculae of hepatocytes and solid areas, the later with a significant amount of black pigment highlighted by Masson-Fontana stain. Immunohistochemistry showed co-expression of C-reactive protein and serum amyloid A in the tumor. Literature review revealed that pigmented HCAs, previously reported as dark adenomas, are rare tumors. In HCAs, the presence of β-catenin activation should be searched for due to the higher risk of malignant transformation in hepatocarcinoma. We describe a pigmented HCA with β-catenin nuclear expression and inflammatory features being the fifth case reported so far.

REFERENCES

1. Grazioli L, Federle MP, Brancatelli G, Ichikawa T, Olivetti L, Blachar A. Hepatic adenomas: imaging and pathologic findings. Radiographics 2001; 21: 877-92.

2. Dhingra S, Fiel MI. Update on the new classification of hepatic adenomas: clinical, molecular, and pathologic characteristics. Arch Pathol Lab Med 2014; 138: 1090-7.

3. Zucman-Rossi J, Jeannot E, Nhieu JT, Scoazec JY, Guettier C, Rebouissou S, Bacq Y, et al. Genotype-phenotype correlation in hepatocellular adenoma: new classification and relationship with HCC. Hepatology 2006; 43: 515-24.

4. Bioulac-Sage P, Laumonier H, Laurent C, Zucman-Rossi J, Balabaud C. Hepatocellular adenoma: what is new in 2008. Hepatol Int 2008; 2: 316-21.

5. Bioulac-Sage P, Rebouissou S, Thomas C, Blanc JF, Saric J, Sa Cunha A, Rullier A, et al. Hepatocellular adenoma subtype classification using molecular markers and immunohistochemistry. Hepatology 2007; 46: 740-8.

6. Bioulac-Sage P, Balabaud C, Wanless I. Focal nodular hyperplasia and hepatocellular adenoma. In: Bosman FT, Carneiro F, Hruban RH, Theise ND (eds.). WHO Classification of Tumours of the Digestive System. 4th Ed. Lyon: IARC Press; 2010, p. 198-204.

7. Ye MQ SA, Ben Haim M, Parsons R, Schwartz ME. A 42- year-old woman with liver masses and long-term use of oral contraceptives. Semin Liver Dis 1999; 19: 339-44.

8. Kitamura T, Alroy J, Gatmaitan Z, Inoue M, Mikami T, Jansen P, Arias IM. Defective biliary excretion of epinephrine metabolites in mutant (TR-) rats: relation to the pathogenesis of black liver in the Dubin-Johnson syndrome and Corriedale sheep with an analogous excretory defect. Hepatology 1992; 15: 1154-9.

9. Roth JA, Berman E, Befeler D, Johnson FB. A black hepatocellular carcinoma with Dubin-Johnson-like pigment and Mallory bodies: a histochemical and ultrastructural study. Am J Surg Pathol 1982; 6: 375-82.

10. Hasan N, Coutts M, Portmann B. Pigmented liver cell adenoma in two male patients. Am J Surg Pathol 2000; 24: 1429-32.

11. Bernard PH, Blanc JF, Paulusma C, Le Bail B, Carles J, Balabaud C, Bioulac-Sage P. Multiple black hepatocellular adenomas in a male patient. Eur J Gastroenterol Hepatol 2000; 12: 1253-7.

12. Ferko A BJ, Nozicka J. Pigmented hepatocellular adenoma of the liver caused by long-term use of phenobarbital. Rozhl Chir 2003; 82: 192-5.

13. Masuda T, Beppu T, Ikeda K, Ishiko T, Chikamoto A, Hayashi H, Okabe H, et al. Pigmented hepatocellular adenoma: report of a case. Surg Today 2011; 41: 881-3.

14. Hechtman JF, Raoufi M, Fiel MI, Taouli B, Facciuto M, Schiano TD, Blouin AG, et al. Hepatocellular carcinoma arising in a pigmented telangiectatic adenoma with nuclear beta-catenin and glutamine synthetase positivity: case report and review of the literature. Am J Surg Pathol 2011; 35: 927-32.

15. Koea JB, Kua H. Pigmented liver cell adenoma: rare but benign. ANZ J Surg 2012; 82: 86-7.

16. Vij M, Patra S, Rela M. Pigmented hepatocellular adenoma with complete CD34 immunostaining pattern: a diagnostic dilemma. Indian J Pathol Microbio 2012; 55: 528-30.

17. Kim GJ, Seok JY, Rhee H, Choi JY, Choi JS, Kim KS, Thung S, et al. Beta-catenin activated hepatocellular adenoma: a report of three cases in Korea. Gut Liver 2014; 8: 452-8.

18. Mounajjed T, Yasir S, Aleff PA, Torbenson MS. Pigmented hepatocellular adenomas have a high risk of atypia and malignancy. Mod Pathol 2015; 28: 1265-74.

19. Farges O, Ferreira N, Dokmak S, Belghiti J, Bedossa P, Paradis V. Changing trends in malignant transformation of hepatocellular adenoma. Gut 2011; 60: 85-9.

20. Dokmak S, Paradis V, Vilgrain V, Sauvanet A, Farges O, Valla D, Bedossa P, et al. A single-center surgical experience of 122 patients with single and multiple hepatocellular adenomas. Gastroenterology 2009; 137: 1698-705.

21. Marsman DS, Goldsworthy TL, Popp JA. Contrasting hepatocytic peroxisome proliferation, lipofuscin accumulation and cell turnover for the hepatocarcinogens Wy-14,643 and clofibric acid. Carcinogenesis 1992; 13: 1011-7.