Hepatocellular adenoma with malignant transformation in male patients with non-cirrhotic livers

Introduction:Hepatocellular adenomas(HCAs),with a risk of malignant transformation into hepatocellular carcinoma(HCQ,classically develop in young women who are taking oral contraceptives.It is now clear that HCAs may also occur in men.However,it is rarely reported that HCAs with malignant transformation occur in male patients with non-cirrhotic livers.This study aimed to characterize the malignancy of HCAs occurring in male patients.Methods:All patients with HCAs with malignant transformation who underwent hepatectomy at the Cancer Institute and Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College between January 1,1999 and December 31,2011 were enrolled in the study.The clinical characteristics as well as radiologic and pathologic data were reviewed.Results:HCAs with malignant transformation were observed in 5 male patients with non-cirrhotic livers,but not in female patients.The alpha-fetoprotein(AFP) levels were higher in patients with HCAs with malignant transformation than in patients with HCAs without malignant transformation.The diameters of the tumors with malignant transformation were larger than 5 cm in 3 cases and smaller than 5 cm in 2 cases.The 5 patients were all alive without recurrence by the end of the study period.The disease-free survival times of the 5 patients were 26,48,69,69,and 92 months.Conclusion:Our results indicate that resection would be advised even if the presumptive diagnosis is adenoma smaller than 5 cm in diameter,especially in male patients.

Malignant transformation of hepatocellular adenoma in a young female patient after ovulation induction fertility treatment:A case report

BACKGROUND Hepatocellular adenoma(HCA) is a rare benign liver tumor usually affecting young women with a history of prolonged use of hormonal contraception.Although the majority is asymptomatic, a low proportion may have significant complications such as bleeding or malignancy. Despite responding to the hormonal stimulus, the desire for pregnancy in patients with small HCA is not contraindicated. However, through this work we demonstrate that intensive hormonal therapies such as those used in the treatment of infertility can trigger serious complications CASE SUMMARY A 33-year-old female with a 10-year history of oral contraceptive use was diagnosed with a hepatic tumor as an incidental finding in an abdominal ultrasound. The patient showed no symptoms and physical examination was unremarkable. Laboratory functional tests were within normal limits and tests for serum tumor markers were negative. An abdominal magnetic resonance imaging(MRI) was performed, showing a 30 mm × 29 mm focal lesion in segment VI of the liver compatible with HCA or Focal Nodular Hyperplasia with atypical behavior. After a total of six years of follow-up, the patient underwent ovulation induction treatment for infertility. On a following MRI, a suspected malignancy was warned and hence, surgery was decided. The surgical specimen revealed malignant transformation of HCA towards trabecular hepatocarcinoma with dedifferentiated areas. There was non-evidence of tumor recurrence after three years of clinical and imaging follow-up.,CONCLUSION HCAs can be malignant regardless its size and low-risk appearance on MRI when an ovultation induction therapy is indicated.

Hepatocellular adenoma in the paediatric population:Molecular classification and clinical associations

Hepatocellular adenomas(HCAs)represent rare,benign liver tumours occurring predominantly in females taking oral contraceptives.In children,HCAs comprise less than 5%of hepatic tumours and demonstrate association with various conditions.The contemporary classification of HCAs,based on their distinctive genotypes and clinical phenotypes,includes hepatocyte nuclear factor 1 homeobox alpha-inactivated HCAs,beta-catenin-mutated HCAs,inflammatory HCAs,combined beta-catenin-mutated and inflammatory HCAs,sonic hedgehogactivated HCAs,and unclassified HCAs.In children,there is a lack of literature on the characteristics and distribution of HCA subtypes.In this review,we summarized different HCA subtypes and the clinicopathologic spectrum of HCAs in the paediatric population.

肝腺瘤分子分类及临床诊治进展

肝腺瘤（hepatocellular adenomas，HCA）是一种罕见的肝脏良性肿瘤，其发生与口服避孕药的应用及雄激素类固醇治疗有很大的关系。肝腺瘤在非口服避孕药的人群中发病率较低，约为每年0．1／10万；在长期服用口服避孕药的人群中发病率较高，为每年3／10万～4／10万。

肝细胞腺瘤亚型MRI影像分析

目的总结MRI征象对肝细胞腺瘤(HCA)各亚型的诊断价值及HCA恶变相关临床、影像表现。方法回顾性分析经手术病理证实的80例HCA的临床及MRI资料,对比HCA各亚型的MRI表现并归纳HCA恶变的相关因素。结果HCA多见于男性(60%),而女性均无口服避孕药史。T1WI、T2WI以及同反相位图像的信号特征,动态扫描强化程度及强化方式等征象在各亚型间差异均有统计学意义(P<0.001~0.011)。同反相位图像上信号弥漫减低是HNF-1α失活型HCA(H-HCA)的特征性表现(敏感性87.5%,特异性95.3%)。"T2WI高信号区域并相关性延迟强化"诊断非H-HCA的敏感性为95%,特异性为44%。慢性乙肝及中心瘢痕与β-catenin激活型HCA(B-HCA)恶变为肝细胞肝癌有显著相关性(P<0.001)。结论MRI联合临床表现有助于鉴别HCA的不同亚型分类和腺瘤恶变并指导临床。