|
1
|
Sandella R, Wollstein Y, Pillai A. Focal Liver Lesions. Am J Gastroenterol 2025; 120:936-938. [PMID: 39436238 DOI: 10.14309/ajg.0000000000003152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Accepted: 10/11/2024] [Indexed: 10/23/2024]
Affiliation(s)
- Rahul Sandella
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Yael Wollstein
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Anjana Pillai
- Division of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medicine, Chicago, Illinois, USA
| |
Collapse
|
|
2
|
Andrews MB, Thota M, Van Name J, Gal T, Sterling R. Clinical phenotypes of benign hepatic lesions: how age, sex, alkaline phosphatase, and hemoglobin can help differentiate. Postgrad Med 2025; 137:287-293. [PMID: 40194992 DOI: 10.1080/00325481.2025.2490469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 03/17/2025] [Accepted: 04/03/2025] [Indexed: 04/09/2025]
Abstract
OBJECTIVES Most benign hepatic lesions occur in isolation. The clinical and demographic phenotype in patients with more than one lesion can overlap complicating treatment decisions. This study aimed to describe the clinical and demographic characteristics of patients with benign hepatic lesions to predict the lesion using clinical data and oral contraceptive (OCP) use and find a 'clinical phenotype' to identify these patients. METHODS This retrospective cohort study compared demographics, laboratory values, and OCP use in patients with hepatic adenoma (HA), focal nodular hyperplasia (FNH), hemangioma (HM), and cystic lesions on imaging. Differences between groups were assessed to identify independent factors associated with the different lesions. RESULTS The cohort (n = 216) contained 90 (41%) FNH, 75 (34%) cystic lesions, 47 (21%) HA, 26 (12%) HM, and 3 (1.4%) FNH+HA. Combination lesions were observed in 27 (12%) patients: HM+cyst (n = 2; 0.9%), FNH+cyst (n = 8; 3.7%), HA+cyst (n = 4; 1.9%), FNH+HM (n = 7; 3.2%), HA+HM (n = 2; 0.9%), FNH+HM+cyst (n = 1; 0.5%), and HA+FNH (n = 3; 1.4%). FNH were youngest and female. HA were young and female with highest OCP use. Patients with cystic lesions were oldest with the least OCP use. HM were male with the highest overall alkaline phosphatase (ALP) levels. Between HA and FNH, HA had significantly higher aspartate aminotransferase, alanine aminotransferase, and ALP levels with lower Hgb levels. CONCLUSION Predicting the etiology of benign hepatic lesions based on patient demographics, common laboratory values, and a brief history including OCP use alone is difficult. However, we identified the most important demographic and laboratory values to assist in building a differential.
Collapse
Affiliation(s)
- Michael B Andrews
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Manaswitha Thota
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Jonathan Van Name
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Tamas Gal
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
- Wright Center for Clinical and Translational Science, Virginia Commonwealth University, Richmond, VA, USA
| | - Richard Sterling
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Wright Center for Clinical and Translational Science, Virginia Commonwealth University, Richmond, VA, USA
- Division of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, VA, USA
- Stravitz-Sanyal Institute for Liver Disease and Metabolic Health, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
|
3
|
Putra J, Kim GE. Diagnostic approach to hepatic vascular lesions: a paediatric perspective. Histopathology 2024; 85:835-845. [PMID: 38924138 DOI: 10.1111/his.15250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 06/04/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024]
Abstract
The pathological evaluation of hepatic vascular lesions in children requires special consideration. Inconsistent terminology, rarity of pathology specimens and overlapping pathological features between various lesions may pose a serious diagnostic challenge. In this review, we highlight the importance of using the International Society for the Study of Vascular Anomalies (ISSVA) classification scheme to characterise these lesions. Selected entities are discussed, including hepatic vascular tumours exclusively seen in the paediatric age group, hepatic infantile haemangioma and hepatic congenital haemangioma. Vascular malformations, with emphasis on their syndromic associations (venous malformation in blue rubber bleb naevus syndrome) and complications (hepatocellular nodules in Abernethy malformation) are also covered.
Collapse
Affiliation(s)
- Juan Putra
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Grace E Kim
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
|
4
|
Tom CK, Ter-Oganesyan R, Shefali C, Kaur N, Pace JL, Rastegarpour A, Genyk Y, Kahn JA. Benign to Malignant Hepatic Lesion Transformation in Abernethy Malformation. ACG Case Rep J 2024; 11:e01307. [PMID: 38586818 PMCID: PMC10997230 DOI: 10.14309/crj.0000000000001307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 02/22/2024] [Indexed: 04/09/2024] Open
Abstract
Abernethy malformation or congenital extrahepatic portosystemic shunt is an extremely rare condition whereby the portomesenteric blood drains into a systemic vein and bypasses the liver through a complete or partial shunt. Severe complications include hyperammonemia and encephalopathy, benign and malignant liver tumors, and hepatopulmonary syndrome. We describe a case where a female adult diagnosed with congenital extrahepatic portosystemic shunt subsequently developed focal nodular hyperplasia and then hepatocellular carcinoma.
Collapse
Affiliation(s)
- Chloe K. Tom
- Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, CA, USA
| | - Ramon Ter-Oganesyan
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Chopra Shefali
- Department of Pathology, University of Southern California, Los Angeles, CA, USA
| | - Navpreet Kaur
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Jordan L. Pace
- California University of Science and Medicine Colton, CA, USA
| | - Ali Rastegarpour
- Department of Diagnostic Radiology, University of Southern California Los Angeles, CA, USA
| | - Yuri Genyk
- Division of Hepatobiliary/Pancreatic and Abdominal Organ Transplant Surgery, University of Southern California Los Angeles, CA, USA
| | - Jeffrey A. Kahn
- Division of Gastrointestinal and Liver Diseases and Liver Transplant Program, University of Southern California Los Angeles, CA, USA
| |
Collapse
|
|
5
|
González IA, Wang D, Pacheco MC, Zhang X, Russo P. Focal Nodular Hyperplasia in the Pediatric Population: A Multicenter Experience. Pediatr Dev Pathol 2023; 26:352-361. [PMID: 37082924 DOI: 10.1177/10935266231167489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND Focal nodular hyperplasia (FNH) is a benign liver lesion classically presenting in young females. In children, FNH is rare and its detailed clinicopathologic characteristics remain largely unknown. Furthermore, there are no studies comparing pediatric FNH features to those presenting in adults. METHODS In this study, we analyzed a total of 47 FNH cases in pediatric patients (age range: 23 days to 18 years) from 3 centers and compared them to a cohort of 31 FNH cases in adult patients (age range: 20-64 years). RESULTS Of the pediatric cases, 13 cases (28%) had a history of a prior malignancy of which 4 were treated with chemoradiation and stem cell transplantation (SCT), 5 with chemoradiation alone and 3 with chemotherapy and SCT. In the pediatric cases 41 (87%) had a central scar and 46 (98%) had fibrous septa. Both pediatric and adult FNH were more common in female patients. Cases in pediatric patients were also significantly associated with larger size (P = .047), absence of dystrophic vessels (P = .001), absence of sinusoidal dilatation (P = .029), pseudoacini formation (P = .013), and steatosis (P = .029). CONCLUSION In our experience although most cases of pediatric FNH show the classic histologic features seen in adults, some significant differences exist, and awareness of these findings could aid in the evaluation of these rare cases.
Collapse
Affiliation(s)
- Iván A González
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Donghai Wang
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Maria Cristina Pacheco
- Department of Laboratory Medicine and Pathology, Seattle Children's, University of Washington, Seattle, WA, USA
| | - Xuchen Zhang
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Pierre Russo
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| |
Collapse
|
|
6
|
Berklite L, Shenoy A, Hollowell M, Fung B, Ranganathan S. Focal Nodular Hyperplasia-Like Lesions With Glypican-3 Positivity in Infancy. Pediatr Dev Pathol 2023; 26:30-38. [PMID: 36546616 DOI: 10.1177/10935266221122934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE AND CONTEXT Glypican-3 is often used to discriminate between neoplastic and nonneoplastic liver. In focal lesions, positivity may be considered suggestive of a malignancy such as hepatoblastoma. However, glypican-3 is also normally expressed in the immature liver. We present a series of 5 cases of focal nodular hyperplasia (FNH)-like lesions arising in very young patients with glypican-3 expression and highlight the challenges these lesions present in the differential diagnosis of hepatoblastoma. METHODS Cases were obtained from the files of 3 tertiary pediatric hospitals. Clinical data were obtained from the electronic medical record and histopathologic material including immunohistochemical stains were reviewed. KEY RESULTS Patients were aged 2 weeks to 6 months with peak AFP levels ranging from 88.6 to 204,696 ng/mL. Microscopically, all were variably demarcated hepatocellular lesions with cords of hepatocytes, marked sinusoidal dilatation, and occasional fibrous bands and areas reminiscent of central scar with bile ducts. No significant cytologic atypia or increased mitotic activity were present. All showed glypican-3 expression and were negative for nuclear beta-catenin with intact reticulin framework. CONCLUSIONS Our study highlights the pitfalls of evaluating focal liver lesions in infants when high AFP levels and glypican-3 expression may reflect immaturity rather than neoplasia.
Collapse
Affiliation(s)
- Lara Berklite
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Archana Shenoy
- Department of Pathology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Monica Hollowell
- Department of Pathology, Boston Children's Hospital, Boston, MA, USA
| | - Bonita Fung
- Department of Pathology, Nationwide Children's Hospital, Columbus, OH, USA
| | | |
Collapse
|
|
7
|
Sayaf K, Gabbia D, Russo FP, De Martin S. The Role of Sex in Acute and Chronic Liver Damage. Int J Mol Sci 2022; 23:10654. [PMID: 36142565 PMCID: PMC9505609 DOI: 10.3390/ijms231810654] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
Acute and chronic hepatic damages are caused by xenobiotics or different diseases affecting the liver, characterized by different etiologies and pathological features. It has been demonstrated extensively that liver damage progresses differently in men and women, and some chronic liver diseases show a more favorable prognosis in women than in men. This review aims to update the most recent advances in the comprehension of the molecular basis of the sex difference observed in both acute and chronic liver damage. With this purpose, we report experimental studies on animal models and clinical observations investigating both acute liver failure, e.g., drug-induced liver injury (DILI), and chronic liver diseases, e.g., viral hepatitis, alcoholic liver disease (ALD), non-alcoholic fatty liver disease (NAFLD), autoimmune liver diseases, and hepatocellular carcinoma (HCC).
Collapse
Affiliation(s)
- Katia Sayaf
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35131 Padova, Italy
| | - Daniela Gabbia
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, 35131 Padova, Italy
| | - Francesco Paolo Russo
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35131 Padova, Italy
- Gastroenterology and Multivisceral Transplant Units, Azienda Ospedale—Università di Padova, 35131 Padova, Italy
| | - Sara De Martin
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, 35131 Padova, Italy
| |
Collapse
|
|
8
|
Denk H, Pabst D, Abuja PM, Reihs R, Tessaro B, Zatloukal K, Lackner C. Senescence markers in focal nodular hyperplasia of the liver: pathogenic considerations on the basis of immunohistochemical results. Mod Pathol 2022; 35:87-95. [PMID: 34645984 DOI: 10.1038/s41379-021-00940-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 02/07/2023]
Abstract
Focal nodular hyperplasia (FNH) is a polyclonal tumour-like hepatic lesion characterised by parenchymal nodules, connective tissue septa without interlobular bile ducts, pronounced ductular reaction and inflammation. It may represent a response to local arterial hyperperfusion and hyperoxygenation resulting in oxidative stress. We aimed at obtaining closer insight into the pathogenesis of FNH with its characteristic morphologic features. Immunohistochemistry and immunofluorescence microscopy was performed on FNH specimens using antibodies against keratins (K) 7 and 19, neural cell adhesion molecule (NCAM), lamin B1, senescence markers (CDK inhibitor 1/p21Cip1, CDK inhibitor /p16Ink4a, senescence-associated (SA) β- galactosidase activity), proliferation markers (Ki-67, proliferating-cell nuclear antigen (PCNA)), and the abnormally phosphorylated histone γ-H2AX, indicating DNA double strand breaks; moreover SA β- galactosidase activity was determined histochemically. Ductular metaplasia of hepatocytes indicated by K7 expression in the absence of K19 plays a major role in the development of ductular reaction in FNH. Moreover, the expression of senescence markers (p21Cip1, p16Ink4a, γ-H2AX, SA β-galactosidase activity) in hepatocytes and cholangiocytes suggests that stress-induced cellular senescence contributes to fibrosis and inflammation via production of components of the senescence-associated secretory phenotype. Expression of proliferation markers (Ki-67, PCNA) was not enhanced in hepatocytes and biliary cells. Senescence and ductular metaplasia of hepatocytes may thus be involved in inflammation, fibrosis and apoptosis resistance. Hence, fibrosis, inflammation and reduced apoptotic cell death, rather than proliferation (hyperplasia) may be responsible for increased tissue mass and tumour-like appearance of FNH.
Collapse
Affiliation(s)
- Helmut Denk
- Diagnostic & Research Centre of Molecular Biomedicine, Institute of Pathology, Medical University of Graz, Graz, Austria.
| | - Daniela Pabst
- Diagnostic & Research Centre of Molecular Biomedicine, Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Peter M Abuja
- Diagnostic & Research Centre of Molecular Biomedicine, Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Robert Reihs
- Diagnostic & Research Centre of Molecular Biomedicine, Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Brigitte Tessaro
- Diagnostic & Research Centre of Molecular Biomedicine, Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Kurt Zatloukal
- Diagnostic & Research Centre of Molecular Biomedicine, Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Carolin Lackner
- Diagnostic & Research Centre of Molecular Biomedicine, Institute of Pathology, Medical University of Graz, Graz, Austria
| |
Collapse
|
|
9
|
Ren H, Gao YJ, Ma XM, Zhou ST. Large focal nodular hyperplasia is unresponsive to arterial embolization: A case report. World J Clin Cases 2021; 9:9977-9981. [PMID: 34877339 PMCID: PMC8610892 DOI: 10.12998/wjcc.v9.i32.9977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/11/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Focal nodular hyperplasia (FNH) commonly occurs in women; it is usually asymptomatic and sometimes difficult to differentiate from hepatocellular carcinoma (HCC).
CASE SUMMARY A large space-occupying lesion in the right lobe of the liver was incidentally detected in an adult man and diagnosed as HCC. Transcatheter arterial chemoembolization was applied once monthly for 2 years, but the lesion did not decrease in size. It was revealed by biopsy to be FNH. Eleven years later, the patient underwent liver resection due to hemorrhage and the pathological examination confirmed FNH.
CONCLUSION For a space-occupying lesion, it is prerequisite to pathologically confirm the diagnosis and the corresponding intervention can be effective.
Collapse
Affiliation(s)
- Hui Ren
- Department of Hepatobiliary and Liver Transplant Center, The Fifth Medical Center, Chinese People’s Liberation Army General Hospital, Beijing 100039, China
| | - Yin-Jie Gao
- Department of Hepatobiliary and Liver Transplant Center, The Fifth Medical Center, Chinese People’s Liberation Army General Hospital, Beijing 100039, China
| | - Xue-Mei Ma
- Department of Hepatobiliary and Liver Transplant Center, The Fifth Medical Center, Chinese People’s Liberation Army General Hospital, Beijing 100039, China
| | - Shao-Tang Zhou
- Department of Hepatobiliary and Liver Transplant Center, The Fifth Medical Center, Chinese People’s Liberation Army General Hospital, Beijing 100039, China
| |
Collapse
|
|
10
|
Dourthe C, Julien C, Di Tommaso S, Dupuy JW, Dugot-Senant N, Brochard A, Le Bail B, Blanc JF, Chiche L, Balabaud C, Bioulac-Sage P, Saltel F, Raymond AA. Proteomic Profiling of Hepatocellular Adenomas Paves the Way to Diagnostic and Prognostic Approaches. Hepatology 2021; 74:1595-1610. [PMID: 33754354 DOI: 10.1002/hep.31826] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/26/2021] [Accepted: 03/11/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Through an exploratory proteomic approach based on typical hepatocellular adenomas (HCAs), we previously identified a diagnostic biomarker for a distinctive subtype of HCA with high risk of bleeding, already validated on a multicenter cohort. We hypothesized that the whole protein expression deregulation profile could deliver much more informative data for tumor characterization. Therefore, we pursued our analysis with the characterization of HCA proteomic profiles, evaluating their correspondence with the established genotype/phenotype classification and assessing whether they could provide added diagnosis and prognosis values. APPROACH AND RESULTS From a collection of 260 cases, we selected 52 typical cases of all different subgroups on which we built a reference HCA proteomics database. Combining laser microdissection and mass-spectrometry-based proteomic analysis, we compared the relative protein abundances between tumoral (T) and nontumoral (NT) liver tissues from each patient and we defined a specific proteomic profile of each of the HCA subgroups. Next, we built a matching algorithm comparing the proteomic profile extracted from a patient with our reference HCA database. Proteomic profiles allowed HCA classification and made diagnosis possible, even for complex cases with immunohistological or genomic analysis that did not lead to a formal conclusion. Despite a well-established pathomolecular classification, clinical practices have not substantially changed and the HCA management link to the assessment of the malignant transformation risk remains delicate for many surgeons. That is why we also identified and validated a proteomic profile that would directly evaluate malignant transformation risk regardless of HCA subtype. CONCLUSIONS This work proposes a proteomic-based machine learning tool, operational on fixed biopsies, that can improve diagnosis and prognosis and therefore patient management for HCAs.
Collapse
Affiliation(s)
- Cyril Dourthe
- Univ. Bordeaux, INSERM, BaRITOn, U1053, Bordeaux, France.,Oncoprot Platform, TBM-Core US 005, Bordeaux, France
| | - Céline Julien
- Univ. Bordeaux, INSERM, BaRITOn, U1053, Bordeaux, France.,Department of Digestive Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Sylvaine Di Tommaso
- Univ. Bordeaux, INSERM, BaRITOn, U1053, Bordeaux, France.,Oncoprot Platform, TBM-Core US 005, Bordeaux, France
| | | | | | | | - Brigitte Le Bail
- Univ. Bordeaux, INSERM, BaRITOn, U1053, Bordeaux, France.,Department of Pathology, Bordeaux University Hospital, Bordeaux, France
| | - Jean-Frédéric Blanc
- Univ. Bordeaux, INSERM, BaRITOn, U1053, Bordeaux, France.,Department of Hepatology and Oncology, Bordeaux University Hospital, Bordeaux, France
| | - Laurence Chiche
- Univ. Bordeaux, INSERM, BaRITOn, U1053, Bordeaux, France.,Department of Digestive Surgery, Bordeaux University Hospital, Bordeaux, France
| | | | | | - Frédéric Saltel
- Univ. Bordeaux, INSERM, BaRITOn, U1053, Bordeaux, France.,Oncoprot Platform, TBM-Core US 005, Bordeaux, France
| | - Anne-Aurélie Raymond
- Univ. Bordeaux, INSERM, BaRITOn, U1053, Bordeaux, France.,Oncoprot Platform, TBM-Core US 005, Bordeaux, France
| |
Collapse
|
|
11
|
Cao JY, Dong Y, Wang WP, Xia HS, Fan PL. Benign Liver Tumors. CONTRAST-ENHANCED ULTRASOUND IMAGING OF HEPATIC NEOPLASMS 2021:101-139. [DOI: 10.1007/978-981-16-1761-4_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
|
|
12
|
Moosavi B, Shenoy-Bhangle AS, Tsai LL, Reuf R, Mortele KJ. MRI characterization of focal liver lesions in non-cirrhotic patients: assessment of added value of gadoxetic acid-enhanced hepatobiliary phase imaging. Insights Imaging 2020; 11:101. [PMID: 32960337 PMCID: PMC7509030 DOI: 10.1186/s13244-020-00894-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/16/2020] [Indexed: 12/15/2022] Open
Abstract
Background To evaluate the added value of the hepatobiliary (HPB) phase in gadoxetic acid-enhanced magnetic resonance imaging (MRI) in characterizing newly discovered indeterminate focal liver lesions in non-cirrhotic patients. Results One-hundred and twenty-five non-cirrhotic patients (median age, 46 years; range, 20–85 years; 100 females) underwent gadoxetic acid-enhanced MRI, including the 20-min delayed HPB phase, for characterization of newly discovered focal liver lesions. Images were independently evaluated by two blinded, board-certified abdominal radiologists (R1 and R2) who characterized liver lesions without and with assessment of the HPB phase images in two separate readout sessions. Confidence in diagnosis was scored on a scale from 0 to 3. Inter-observer agreement was assessed using Cohen κ statistics. Change in diagnosis and confidence in diagnosis were evaluated by Wilcoxon signed rank test. There was no significant change in diagnosis before and after evaluation of the HPB phase for both readers (p = 1.0 for R1; p = 0.34 for R2). Confidence in diagnosis decreased from average 2.8 ± 0.45 to 2.6 ± 0.59 for R1 and increased from 2.6 ± 0.83 to 2.8 ± 0.46 for R2. Change in confidence was only statistically significant for R1 (p = 0.003) but not significant for R2 (p = 0.49). Inter-reader agreement in diagnosis was good without (k = 0.66) and with (k = 0.75) inclusion of the HPB phase images. Conclusions The added information obtained from the HPB phase of gadoxetic acid-enhanced MRI does not change the diagnosis or increase confidence in diagnosis when evaluating new indeterminate focal liver lesions in non-cirrhotic patients.
Collapse
Affiliation(s)
- Bardia Moosavi
- Department of Radiology, Hull Hospital, Gatineau, Quebec, J8Y1W7, Canada.
| | - Anuradha S Shenoy-Bhangle
- Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Leo L Tsai
- Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Robert Reuf
- Department of Radiology, Hull Hospital, Gatineau, Quebec, J8Y1W7, Canada.,Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Koenraad J Mortele
- Department of Radiology, Hull Hospital, Gatineau, Quebec, J8Y1W7, Canada.,Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| |
Collapse
|
|
13
|
Yusa T, Okabe H, Yamashita YI, Nitta H, Nakao Y, Itoyama R, Yamao T, Higashi T, Yamamura K, Imai K, Hayashi H, Baba H. A case of inferior right hepatic vein-right hepatic vein bypass with interrupted inferior vena cava compressed by focal nodular hyperplasia in caudate lobe. Int Cancer Conf J 2020; 10:11-14. [PMID: 33489694 DOI: 10.1007/s13691-020-00439-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/07/2020] [Indexed: 11/29/2022] Open
Abstract
Focal nodular hyperplasia (FNH) is a relatively common benign liver tumor with rare indications to surgery. Budd-Chiari syndrome is a rare condition caused by interrupted hepatic venous outflow in the hepatic veins and inferior vena cava (IVC). A 42-year-old woman was referred to our department with a hepatic tumor. Patient's chief complaint was leg edema. Because of this symptom, it was difficult for the patient to stand for more than 20 min in the evening. Computed tomography (CT) showed a hypervascular mass compressing IVC in the caudate lobe of the liver. Fine needle aspiration was performed, and preoperative diagnosis was focal nodular hyperplasia (FNH). Hepatic resection of the right caudate lobe was performed. Postoperative histological examination revealed that the tumor was FNH. After surgery, the patient's leg edema disappeared, and postoperative CT revealed that severe IVC stenosis was improved. Although there have been several reports of giant FNH causing Budd-Chiari syndrome, this case shows the stenosis of IVC below the root of hepatic veins causing Budd-Chiari-like syndrome without portal hypertension. The location of the tumor considerably attributed to the congestion of venous flow in IVC causing various symptoms and intrahepatic inferior right hepatic vein-right hepatic vein bypass. The surgical indication of FNH is limited in most cases; however, the current report alerts that the location of FNH should be taken into account when monitoring it.
Collapse
Affiliation(s)
- Toshihiko Yusa
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, Kumamoto 860-8556 Japan
| | - Hirohisa Okabe
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, Kumamoto 860-8556 Japan
| | - Yo-Ichi Yamashita
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, Kumamoto 860-8556 Japan
| | - Hidetoshi Nitta
- Department of Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Yosuke Nakao
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, Kumamoto 860-8556 Japan
| | - Rumi Itoyama
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, Kumamoto 860-8556 Japan
| | - Takanobu Yamao
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, Kumamoto 860-8556 Japan
| | - Takaaki Higashi
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, Kumamoto 860-8556 Japan
| | - Kensuke Yamamura
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, Kumamoto 860-8556 Japan
| | - Katsunori Imai
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, Kumamoto 860-8556 Japan
| | - Hiromitsu Hayashi
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, Kumamoto 860-8556 Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, Kumamoto 860-8556 Japan
| |
Collapse
|
|
14
|
Agostini CH, Ribeiro OD, Fernandes A, Caroli-Bottino A, Pannain VL. Relevance of morphological features for hepatocellular adenoma classification in pathology practice. SURGICAL AND EXPERIMENTAL PATHOLOGY 2020. [DOI: 10.1186/s42047-020-00061-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Gene mutations correlated with histological and immunohistochemical phenotypes of hepatocellular adenoma were recently identified. Based on these findings, four adenoma subtypes were distinguished. We classify hepatocellular adenoma (HCA) into subtypes based on histologic and immunohistochemical findings and verify the contribution of histological features in pathology practice.
Methods
Thirty hepatocellular adenomas were classified in subtypes. Sinusoidal dilatation, ductular reaction, pseudoportal tracts, pseudoglands, steatosis, inflammatory infiltrate and cellular atypia were analyzed, as well as liver fatty acid binding protein, β catenin, serum amyloid A, glutamine synthetase, and C-reactive protein antibodies.
Results
Histologically, eleven adenomas were classified as HNF1A inactivated (HHCA), five were β-catenin-activated (bHCA) and fourteen were inflammatory adenoma (IHCA). Steatosis was found in all HHCA and was predominantly severe. Sinusoidal dilatation and inflammatory infiltrate were present in all IHCA. Ductular reaction, pseudoportal tracts and cellular atypia were observed in 71.4, 85.7 and 42.8%, respectively. Pseudoglands were present in 60% and cellular atypia in 80% of bHCA. According to immunohistochemistry, 11 were HHCA; 1 was bHCA; 17 were IHCA, among which 5 were β-catenin activated IHCA; and 1 was unclassified UHCA (UHCA). Superior concordance between the histological and immunohistochemical classifications was found for HHCA (К = 0.854) and IHCA (К = 0.657).
Conclusion
Approximately 90% of adenomas may be diagnosed by subgroup based only on morphological features. When aberrant β catenin nuclear staining is not found, glutamine synthetase positivity is useful for diagnosis, although supplementary molecular analysis may be necessary.
Collapse
|
|
15
|
Evaluation of texture analysis for the differential diagnosis of focal nodular hyperplasia from hepatocellular adenoma on contrast-enhanced CT images. Abdom Radiol (NY) 2019; 44:1323-1330. [PMID: 30267107 DOI: 10.1007/s00261-018-1788-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To explore the value of CT texture analysis (CTTA) for differentiation of focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA) on contrast-enhanced CT (CECT). METHODS This is a retrospective, IRB-approved study conducted in a single institution. A search of the medical records between 2008 and 2017 revealed 48 patients with 70 HCA and 50 patients with 62 FNH. All lesions were histologically proven and with available pre-operative CECT imaging. Hepatic arterial phase (HAP) and portal venous phase (PVP) were used for CTTA. Textural features were extracted using a commercially available research software (TexRAD). The differences between textural parameters of FNH and HCA were assessed using the Mann-Whitney U test and the AUROC were calculated. CTTA parameters showing significant difference in rank sum test were used for binary logistic regression analysis. A p value < 0.05 was considered statistically significant. RESULTS On HAP images, mean, mpp, and skewness were significantly higher in FNH than in HCA on unfiltered images (p ≤ 0.007); SD, entropy, and mpp on filtered analysis (p ≤ 0.006). On PVP, mean, mpp, and skewness in FNH were significantly different from HCA (p ≤ 0.001) on unfiltered images, while entropy and kurtosis were significantly higher in FNH on filtered images (p ≤ 0.018). The multivariate logistic regression analysis indicated that the mean, mpp, and entropy of medium-level and coarse-level filtered images on HAP were independent predictors for the diagnosis of HCA and a model based on all these parameters showed the largest AUROC (0.824). CONCLUSIONS Multiple explored CTTA parameters are significantly different between FNH and HCA on CECT.
Collapse
|
|
16
|
Value of Texture Analysis on Gadoxetic Acid-Enhanced MRI for Differentiating Hepatocellular Adenoma From Focal Nodular Hyperplasia. AJR Am J Roentgenol 2018; 212:538-546. [PMID: 30557050 DOI: 10.2214/ajr.18.20182] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The objective of our study was to assess the diagnostic performance of texture analysis (TA) on gadoxetic acid-enhanced MR images for differentiation of hepatocellular adenoma (HCA) from focal nodular hyperplasia (FNH). MATERIALS AND METHODS This study included 40 patients (39 women and one man) with 51 HCAs and 28 patients (27 women and one man) with 32 FNH lesions. All lesions were histologically proven with preoperative MRI performed with gadoxetic acid. Two readers reviewed all the imaging sequences to assess the qualitative MRI characteristics. The T2-weighted fast spin-echo, hepatic arterial phase (HAP), and hepatobiliary phase (HBP) sequences were used for TA. Textural features were extracted using commercially available software (TexRAD). The differences in distributions of TA parameters of FNHs and HCAs were assessed using the Mann-Whitney U test. Area under the ROC curve (AUROC) values were calculated for statistically significant features. A logistic regression analysis was conducted to explore the added value of TA. A p value < 0.002 was considered statistically significant after Bonferroni correction for multiple comparisons. RESULTS Multiple TA parameters showed a statistically different distribution in HCA and FNH including skewness on T2-weighted imaging, skewness on HAP imaging, skewness on HBP imaging, and entropy on HBP imaging (p < 0.001). Skewness on HBP imaging showed the largest AUROC (0.869; 95% CI, 0.777-0.933). A skewness value on HBP imaging of greater than -0.06 had a sensitivity of 72.5% and a specificity of 90.6% for the diagnosis of HCA. Six of 51 (11.8%) HCAs lacked hypointensity on HBP imaging. A binary logistic regression analysis including hypointensity on HBP imaging and the statistically significant TA parameters yielded an AUROC of 0.979 for the diagnosis of HCA and correctly predicted 96.4% of the lesions. CONCLUSION TA may be of added value for the diagnosis of atypical HCA presenting without hypointensity on HBP imaging.
Collapse
|
|
17
|
MicroRNA Expression in Focal Nodular Hyperplasia in Comparison with Cirrhosis and Hepatocellular Carcinoma. Pathol Oncol Res 2018; 25:1103-1109. [PMID: 30411298 DOI: 10.1007/s12253-018-0528-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 10/29/2018] [Indexed: 02/07/2023]
Abstract
The liver disease focal nodular hyperplasia (FNH) has several histological features that resemble hepatic cirrhosis. Since cirrhosis may develop further into hepatocellular carcinoma (HCC) contrary to FNH, the aim of the present study was to identify microRNAs (miRNA), which, by their altered expression levels, may be associated with the benign, tumor-like nature of FNH. Altogether 106 surgically removed formalin-fixed paraffin-embedded liver samples were selected, including 22 FNH, 45 cirrhosis, 24 HCC and 15 normal liver tissues. Etiology of the cases of cirrhosis and HCC includes hepatitis C and alcoholism and the HCC cases developed in cirrhotic livers. Relative expression levels of 14 miRNAs were determined using TaqMan MicroRNA Assays. In comparison to normal liver, the levels of miR-34a and miR-224 were elevated not only in FNH but also in cirrhosis and HCC, while the expression of miR-17-5p, miR-18a and miR-210 was decreased in FNH. Further, the levels of miR-21 and miR-222 were increased in cirrhosis and HCC but were decreased in FNH and the expression of miR-17-5p, miR-18a, miR-195 and miR-210 was decreased in FNH as compared with cirrhosis and/or HCC. In conclusion, the elevation of miR-34a and miR-224 may be associated with both benign and malignant proliferative processes, nevertheless the increased expression of oncomiRs miR-21 and miR-222 in cirrhosis and HCC but not in FNH may be related to malignant processes of the liver. The decreased levels of miR-18a, miR-195 and miR-210 may further differentiate FNH from cirrhosis, reflecting the different pathogenesis of these two entities contrary to some histologically similar features.
Collapse
|
|
18
|
Vanhooymissen IJ, Thomeer MG, Braun LM, Gest B, van Koeverden S, Willemssen FE, Hunink M, De Man RA, Ijzermans JN, Dwarkasing RS. Intrapatient Comparison of the Hepatobiliary Phase of Gd-BOPTA and Gd-EOB-DTPA in the Differentiation of Hepatocellular Adenoma From Focal Nodular Hyperplasia. J Magn Reson Imaging 2018; 49:700-710. [DOI: 10.1002/jmri.26227] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/15/2018] [Accepted: 05/30/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
| | - Maarten G. Thomeer
- Department of Radiology; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - Loes M.M. Braun
- Department of Radiology; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - Bibiche Gest
- Department of Radiology; Peter MacCallum Cancer Centre Melbourne; Australia
| | | | - Francois E. Willemssen
- Department of Radiology; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - Myriam Hunink
- Department of Epidemiology and Department of Radiology; Erasmus MC University Medical Center Rotterdam, The Netherlands and Harvard T.H. Chan School of Public Health; Boston Massachusetts USA
| | - Robert A. De Man
- Department of Gastroenterology and Hepatology; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - Jan N. Ijzermans
- Department of Surgery; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - Roy S. Dwarkasing
- Department of Radiology; Erasmus MC University Medical Center; Rotterdam The Netherlands
| |
Collapse
|
|
19
|
Amico EC, Alves JR, Souza DLBD, Salviano FAM, João SA, Liguori ADAL. HYPERVASCULAR LIVER LESIONS IN RADIOLOGICALLY NORMAL LIVER. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2018; 30:21-26. [PMID: 28489163 PMCID: PMC5424681 DOI: 10.1590/0102-6720201700010007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/10/2017] [Indexed: 12/21/2022]
Abstract
Background: The hypervascular liver lesions represent a diagnostic challenge. Aim: To identify risk factors for cancer in patients with non-hemangiomatous hypervascular hepatic lesions in radiologically normal liver. Method: This prospective study included patients with hypervascular liver lesions in radiologically normal liver. The diagnosis was made by biopsy or was presumed on the basis of radiologic stability in follow-up period of one year. Cirrhosis or patients with typical imaging characteristics of haemangioma were excluded. Results: Eighty-eight patients were included. The average age was 42.4. The lesions were unique and were between 2-5 cm in size in most cases. Liver biopsy was performed in approximately 1/3 of cases. The lesions were benign or most likely benign in 81.8%, while cancer was diagnosed in 12.5% of cases. Univariate analysis showed that age >45 years (p< 0.001), personal history of cancer (p=0.020), presence of >3 nodules (p=0.003) and elevated alkaline phosphatase (p=0.013) were significant risk factors for cancer. Conclusion: It is safe to observe hypervascular liver lesions in normal liver in patients up to 45 years, normal alanine aminotransaminase, up to three nodules and no personal history of cancer. Lesion biopsies are safe in patients with atypical lesions and define the treatment to be established for most of these patients.
Collapse
Affiliation(s)
- Enio Campos Amico
- Gastrocentro Clinic and Clinic for Digestive Tract Surgery and Hepato-biliary-pancreatic Surgery, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - José Roberto Alves
- Gastrocentro Clinic and Clinic for Digestive Tract Surgery and Hepato-biliary-pancreatic Surgery, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Dyego Leandro Bezerra de Souza
- Gastrocentro Clinic and Clinic for Digestive Tract Surgery and Hepato-biliary-pancreatic Surgery, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Fellipe Alexandre Macena Salviano
- Gastrocentro Clinic and Clinic for Digestive Tract Surgery and Hepato-biliary-pancreatic Surgery, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Samir Assi João
- Gastrocentro Clinic and Clinic for Digestive Tract Surgery and Hepato-biliary-pancreatic Surgery, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Adriano de Araújo Lima Liguori
- Gastrocentro Clinic and Clinic for Digestive Tract Surgery and Hepato-biliary-pancreatic Surgery, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| |
Collapse
|
|
20
|
Hepatocellular adenoma in a woman who was undergoing testosterone treatment for gender identity disorder. Clin J Gastroenterol 2018; 11:401-410. [PMID: 29589251 DOI: 10.1007/s12328-018-0854-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/18/2018] [Indexed: 02/06/2023]
Abstract
A 32-year-old Japanese woman was admitted to our hospital for the diagnosis and treatment of multiple liver tumors. She had been receiving 125 mg testosterone enanthate every 2 weeks following female-to-male gender identity disorder (GID) diagnosis at 20 years of age. Ultrasonography, computed tomography, and magnetic resonance imaging showed 11 hepatic nodular tumors with a maximum diameter of 28 mm. Liver tumors with hepatocellular adenoma (HCA) were diagnosed with needle biopsy. Segmentectomy of the left lateral lobe including two lesions, subsegmentectomy of S6 including two lesions, enucleation of each tumor in S5 and S7, and open surgical radiofrequency ablation for each tumor in S4 and S7 were performed. Immunohistochemical specimens showed that the tumor cells were diffusely and strongly positive for glutamine synthetase and that the nuclei were ectopically positive for β-catenin. Thus, the tumors were diagnosed as β-catenin-activated HCA (b-HCA). Transcatheter arterial chemoembolization plus subsequent radiofrequency ablation was performed for the 3 residual lesions in S4 and S8. Although testosterone enanthate was being continued for GID, no recurrence was observed until at least 22 months after the intensive treatments. HCA development in such patients receiving testosterone should be closely monitored using image inspection.
Collapse
|
|
21
|
Steatohepatitis-like Changes in Focal Nodular Hyperplasia, A Finding to Distinguish From Steatohepatitic Variant of Hepatocellular Carcinoma. Am J Surg Pathol 2017; 41:277-281. [PMID: 28079599 DOI: 10.1097/pas.0000000000000781] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Steatohepatitis-like change has not been described in focal nodular hyperplasia (FNH). Steatohepatitis-like change in FNH may show overlapping features with steatohepatitic variant of hepatocellular carcinoma (HCC). This problem can be compounded if seen in FNH with widened cell plates or hepatocyte rosettes, other features that can also be seen in HCC. This study examined steatotic FNHs for the frequency of steatohepatitis-like change, especially in the setting of FNH with rosettes and/or widened cell plates. Thirty-three resection specimens of steatotic FNH from 3 institutions were evaluated for degree of steatosis, background liver steatosis, ductular reaction, and lymphocytic infiltrate, as well as presence of thick fibrous bands, thick-walled vessels, ballooned hepatocytes, Mallory-Denk bodies, dilated sinusoids, hepatocyte rosettes, and thick hepatic plates. Steatosis was distributed along fibrous septa as well as diffusely throughout the FNH. Steatohepatitis-like changes were focally present in 54% (18 cases). Thick plates>3 cells were focally found in 14 cases (42%); rosettes were common (70%). All cases showed at least 2 of the histologic features highly suggestive for the diagnosis of FNH such as thick bands of fibrosis, thick-walled vessels and/or ductular reaction and the typical map-like pattern of glutamine synthetase immunostaining. More than half of fatty FNH examined for this study had features of at least focal steatohepatitis-like changes. This finding should not be confused with steatohepatitic variant of HCC. Common typical features of FNH including thick-walled vessels, ductular reaction and thick fibrous bands are helpful for discrimination of FNH from HCC.
Collapse
|
|
22
|
Roncalli M, Sciarra A, Tommaso LD. Benign hepatocellular nodules of healthy liver: focal nodular hyperplasia and hepatocellular adenoma. Clin Mol Hepatol 2016; 22:199-211. [PMID: 27189732 PMCID: PMC4946404 DOI: 10.3350/cmh.2016.0101] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 04/01/2016] [Indexed: 02/06/2023] Open
Abstract
Owing to the progress of imaging techniques, benign hepatocellular nodules are increasingly discovered in the clinical practice. This group of lesions mostly arises in the context of a putatively normal healthy liver and includes either pseudotumoral and tumoral nodules. Focal nodular hyperplasia and hepatocellular adenoma are prototypical examples of these two categories of nodules. In this review we aim to report the main pathological criteria of differential diagnosis between focal nodular hyperplasia and hepatocellular adenoma, which mainly rests upon morphological and phenotypical features. We also emphasize that for a correct diagnosis the clinical context such as sex, age, assumption of oral contraceptives, associated metabolic or vascular disturbances is of paramount importance. While focal nodular hyperplasia is a single entity epidemiologically more frequent than adenoma, the latter is representative of a more heterogeneous group which has been recently and extensively characterized from a clinical, morphological, phenotypical and molecular profile. The use of the liver biopsy in addition to imaging and the clinical context are important diagnostic tools of these lesions. In this review we will survey their systematic pathobiology and propose a diagnostic algorithm helpful to increase the diagnostic accuracy of not dedicated liver pathologists. The differential diagnosis between so-called typical and atypical adenoma and well differentiated hepatocellular carcinoma will also be discussed.
Collapse
Affiliation(s)
- Massimo Roncalli
- Pathology Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Amedeo Sciarra
- Pathology Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.,University of Milan School of Medicine, Milan, Italy
| | - Luca Di Tommaso
- Pathology Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| |
Collapse
|
|
23
|
Alnajjar A, Al-Hussaini H, Al Sebayel M, Al-Kattan W, Elsiesy H. Liver Transplantation for Budd-Chiari Syndrome With Large Solitary Focal Nodular Hyperplasia of the Liver in a Patient With Essential Thrombocythemia: Case Report. [Corrected]. Transplant Proc 2016; 47:2282-6. [PMID: 26361700 DOI: 10.1016/j.transproceed.2015.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 05/14/2015] [Indexed: 02/01/2023]
Abstract
Budd-Chiari syndrome is a rare condition caused by interrupted hepatic venous outflow in the hepatic veins, inferior vena cava, or right atrium. Reports from the literature have delineated on focal nodular hyperplasia (FNH)-like lesions in association with Budd-Chiari Syndrome. To our knowledge, there are no reports about true FNH lesions in patients with Budd-Chiari Syndrome. Focal nodular hyperplasia develops in disorders with aberrant circulation and vasculature. We report a case of Budd-Chiari syndrome in association with large solitary FNH in a 22-year-old man who was referred to our institution with sudden intermittent right upper quadrant abdominal pain, vomiting, diarrhea with pale stool, decreased appetite, dark urine, and abdominal distention for 15 days. Laboratory investigations revealed anemia, thrombocytosis, and abnormal liver function tests and coagulation profile. Imaging revealed hepatic vein thrombosis, confirming Budd-Chiari syndrome, and a 6.2 × 6.1 × 6.8 cm lesion in segment 8 of the liver. Primary cause of Budd-Chiari syndrome was essential thrombocythemia according to bone marrow biopsy and molecular testing results. The patient was treated medically and underwent transjugular intrahepatic portosystemic shunt insertion. The lesion in segment 8 continued to enlarge. Cadaveric liver transplantation was carried out. On gross and histologic examination of the explanted liver, the lesion was found to be a true FNH.
Collapse
Affiliation(s)
- A Alnajjar
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - H Al-Hussaini
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - M Al Sebayel
- Department of Liver and Small Bowel Transplantation and Hepatobiliary and Pancreatic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - W Al-Kattan
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - H Elsiesy
- Department of Liver and Small Bowel Transplantation and Hepatobiliary and Pancreatic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| |
Collapse
|
|
24
|
Goltz D, Fischer HP. [Hepatocellular tumours in noncirrhotic liver tissue]. DER PATHOLOGE 2015; 36:597-606; quiz 607-8. [PMID: 26496997 DOI: 10.1007/s00292-015-0113-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In recent years, the spectrum of tissue-based diagnostics of hepatocellular tumours has changed due to novel molecular pathological findings. Innovative radiographics filter out small lesions and ambiguous tumours for bioptical sampling. The spectrum of these tumours includes hepatocellular carcinoma, hepatocellular adenomas, focal nodular hyperplasia and macroregenerative nodules. Primarily, morphological analysis should identify the dignity of a lesion. After exclusion of HCC and reactive liver cell nodules, hepatocellular adenomas should be further subclassified based on immunohistochemical/molecular pathological criteria according to the WHO classification of liver tumours. This procedure provides significant additional information regarding the prognosis and therapeutic implications of hepatocellular adenomas.
Collapse
|
|
25
|
Current Proceedings in the Molecular Dissection of Hepatocellular Adenomas: Review and Hands-on Guide for Diagnosis. Int J Mol Sci 2015; 16:20994-1007. [PMID: 26404250 PMCID: PMC4613237 DOI: 10.3390/ijms160920994] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 08/10/2015] [Accepted: 08/19/2015] [Indexed: 02/07/2023] Open
Abstract
Molecular dissection of hepatocellular adenomas has brought forward a diversity of well-defined entities. Their distinction is important for routine practice, since prognosis is tightly related to the individual subgroup. Very recent activity has generated new details on the molecular background of hepatocellular adenoma, which this article aims to integrate into the current concepts of taxonomy.
Collapse
|
|
26
|
Koehne de Gonzalez AK, Salomao MA, Lagana SM. Current concepts in the immunohistochemical evaluation of liver tumors. World J Hepatol 2015; 7:1403-1411. [PMID: 26052385 PMCID: PMC4450203 DOI: 10.4254/wjh.v7.i10.1403] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/01/2015] [Accepted: 03/05/2015] [Indexed: 02/06/2023] Open
Abstract
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 is seen 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.
Collapse
|
|
27
|
Margonis GA, Ejaz A, Spolverato G, Rastegar N, Anders R, Kamel IR, Pawlik TM. Benign solid tumors of the liver: management in the modern era. J Gastrointest Surg 2015; 19:1157-68. [PMID: 25560181 DOI: 10.1007/s11605-014-2723-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 12/04/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Recently, there has been a growing interest in solid benign liver tumors as the understanding of the pathogenesis and molecular underpinning of these lesions continues to evolve. We herein provide an evidence-based review of benign solid liver tumors with particular emphasis on the diagnosis and management of such tumors. METHODS A search of all available literature on benign hepatic tumors through a search of the MEDLINE/PubMed electronic database was conducted. RESULTS New diagnostic and management protocols for benign liver tumors have emerged, as well as new insights into the molecular pathogenesis. In turn, these data have spawned a number of new studies seeking to correlate molecular, clinicopathological, and clinical outcomes for benign liver tumors. In addition, significant advances in surgical techniques and perioperative care have reduced the morbidity and mortality of liver surgery. Despite current data that supports conservative management for many patients with benign liver tumors, patients with severe preoperative symptomatic disease seem to benefit substantially from surgical treatment based on quality of life data. CONCLUSION Future studies should seek to further advance our understanding of the underlying pathogenesis and natural history of benign liver tumors in order to provide clinicians with evidence-based guidelines to optimize treatment of patients with these lesions.
Collapse
Affiliation(s)
- Georgios Antonios Margonis
- Department of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA
| | | | | | | | | | | | | |
Collapse
|
|
28
|
McInnes MDF, Hibbert RM, Inácio JR, Schieda N. Focal Nodular Hyperplasia and Hepatocellular Adenoma: Accuracy of Gadoxetic Acid-enhanced MR Imaging--A Systematic Review. Radiology 2015; 277:413-23. [PMID: 26020440 DOI: 10.1148/radiol.2015142986] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To perform a systematic review to evaluate the diagnostic accuracy of hepatobiliary (HPB) phase gadoxetic acid-enhanced MR imaging of the liver in the diagnosis of focal nodular hyperplasia (FNH) versus hepatocellular adenoma (HCA) and to identify the rate of (a) reported HCAs that are iso- or hyperintense to liver and (b) reported FNHs that are hypointense to liver on HPB phase MR images. MATERIALS AND METHODS The institutional review board granted a waiver for this study type, and multiple databases were searched for studies in which researchers distinguished between FNH and HCA with gadoxetic acid-enhanced MR imaging. Studies to evaluate diagnostic accuracy were included; case reports and series were included to analyze the rate of iso- or hyperintense HCAs on HPB phase MR images. Risk of bias was assessed by using the Quality Assessment Tool for Diagnostic Accuracy Studies-2. Sensitivity and specificity were plotted with a forest plot; pooling was not performed because a small number of heterogeneous studies were included. Rate of iso- or hyperintense HCA on HPB phase gadoxetic acid-enhanced MR images was evaluated. RESULTS Six studies (309 patients; 164 with HCA, 233 with FNH) were included for diagnostic accuracy assessment. Twelve case series (129 patients; 81 with HCA, 70 with FNH) were included (studies with insufficient 2 × 2 table data for diagnostic accuracy assessment). Sensitivity was high (range, 0.91-1.00; lower margin of the 95% confidence interval: 0.77). Specificity was high (range, 0.87-1.00; lower margin of the 95% confidence interval: 0.54). Specificity was lowest among studies in which molecular subtyping of HCA was performed. Rate of iso-or hyperintensity of HCA on HPB phase MR images was variable (range, 0%-67%) and occurred more frequently in the inflammatory subtype. High risk of bias was identified in the domains of patient selection and reference standard. CONCLUSION The reported diagnostic accuracy of HPB phase gadoxetic acid-enhanced MR imaging in the diagnosis of HCA versus FNH is high; however, studies are few, heterogeneous, and at high risk for bias, indicating that diagnostic accuracy may be overestimated.
Collapse
Affiliation(s)
- Matthew D F McInnes
- From the Department of Radiology, Clinical Epidemiology Program, University of Ottawa, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa Hospital Civic Campus, Room c159, Ottawa ON, Canada K1Y 4E9
| | - Rebecca M Hibbert
- From the Department of Radiology, Clinical Epidemiology Program, University of Ottawa, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa Hospital Civic Campus, Room c159, Ottawa ON, Canada K1Y 4E9
| | - João R Inácio
- From the Department of Radiology, Clinical Epidemiology Program, University of Ottawa, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa Hospital Civic Campus, Room c159, Ottawa ON, Canada K1Y 4E9
| | - Nicola Schieda
- From the Department of Radiology, Clinical Epidemiology Program, University of Ottawa, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa Hospital Civic Campus, Room c159, Ottawa ON, Canada K1Y 4E9
| |
Collapse
|
|
29
|
Siegelman ES, Chauhan A. MR characterization of focal liver lesions: pearls and pitfalls. Magn Reson Imaging Clin N Am 2015; 22:295-313. [PMID: 25086931 DOI: 10.1016/j.mric.2014.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Magnetic resonance (MR) can characterize specific tissue subtypes, thus facilitating focal liver lesion diagnosis. Focal liver lesions that are isointense to hyperintense to liver on T1-weighted images are usually hepatocellular in origin. Chemical shift imaging can narrow the differential diagnosis by detecting the presence of lipid or iron. T2 and heavily T2-weigthed fast spin echo imaging can differentiate solid from nonsolid focal liver lesions. The authors illustrate these MR imaging pearls and the uncommon exceptions (pitfalls). The authors hope that you will find this less traditional contribution to the Magnetic Resonance Clinics of North America helpful in clinical practice.
Collapse
Affiliation(s)
- Evan S Siegelman
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 34th and Spruce Streets, 1st Floor Silverstein, Philadelphia, PA 19104-4283, USA.
| | - Anil Chauhan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 34th and Spruce Streets, 1st Floor Silverstein, Philadelphia, PA 19104-4283, USA
| |
Collapse
|
|
30
|
Chen ZE, Lin F. Application of immunohistochemistry in gastrointestinal and liver neoplasms: new markers and evolving practice. Arch Pathol Lab Med 2015; 139:14-23. [PMID: 25549141 DOI: 10.5858/arpa.2014-0153-ra] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Diagnosis of primary gastrointestinal and liver neoplasms is usually straightforward. Immunohistochemistry is most helpful to differentiate metastatic carcinomas with morphologic similarity and to resolve tumors of unknown origin. Recently, several new markers highly sensitive and specific for primary liver and gastrointestinal tumors have been discovered. Their potential diagnostic application has not been widely appreciated by general practicing pathologists. In addition, a new trend in immunohistochemistry application has started, focusing on assessing predictive markers (such as human epidermal growth factor receptor 2) and mutation-specific markers (v-raf murine sarcoma viral oncogene homolog B V600E) to directly guide clinical management. Practicing pathologists need to be aware of and prepared for this evolving trend. OBJECTIVES To summarize the usefulness of several recently discovered immunohistochemical markers in the study of gastrointestinal and liver tumors; to suggest the most current and effective immunohistochemical panels addressing common diagnostic challenges for these tumors; to share practical experience and useful tips for human epidermal growth factor receptor 2 testing in gastric and gastroesophageal junction adenocarcinoma and v-raf murine sarcoma viral oncogene homolog B V600E immunohistochemistry in colorectal carcinoma. DATA SOURCES Sources include literature review, and authors' research data and practice experience. The cases illustrated are selected from the pathology archives of the Geisinger Medical Center (Danville, Pennsylvania). CONCLUSIONS Application of immunohistochemistry in gastrointestinal and liver tumors continues to evolve. New tumor-specific markers constantly emerge and help pathologists to further improve diagnostic accuracy. Assessment of predictive and prognostic markers by immunohistochemistry in routine pathologic diagnosis is a new trend and will greatly facilitate the advancement of personalized cancer therapy.
Collapse
Affiliation(s)
- Zongming Eric Chen
- From the Department of Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania
| | | |
Collapse
|
|
31
|
Current updates on the molecular genetics and magnetic resonance imaging of focal nodular hyperplasia and hepatocellular adenoma. Insights Imaging 2015; 6:347-62. [PMID: 25790815 PMCID: PMC4444792 DOI: 10.1007/s13244-015-0399-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/29/2015] [Accepted: 02/04/2015] [Indexed: 12/19/2022] Open
Abstract
UNLABELLED Focal nodular hyperplasia (FNH) and hepatocellular adenomas (HCAs) constitute benign hepatic neoplasms in adults. HCAs are monoclonal neoplasms characterised by an increased predilection to haemorrhage and also malignant transformation. On the other hand, FNH is a polyclonal tumour-like lesion that occurs in response to increased perfusion and has an uneventful clinical course. Recent advances in molecular genetics and genotype-phenotype correlation in these hepatocellular neoplasms have enabled a new classification system. FNHs are classified into the typical and atypical types based on histomorphological and imaging features. HCAs have been categorised into four subtypes: (1) HCAs with HNF-1α mutations are diffusely steatotic, do not undergo malignant transformation, and are associated with familial diabetes or adenomatosis. (2) Inflammatory HCAs are hypervascular with marked peliosis and a tendency to bleed. They are associated with obesity, alcohol and hepatic steatosis. (3) HCAs with β-catenin mutations are associated with male hormone administration and glycogen storage disease, frequently undergo malignant transformation and may simulate hepatocellular carcinoma on imaging. (4) The final type is unclassified HCAs. Each of these except the unclassified subtype has a few distinct imaging features, often enabling reasonably accurate diagnosis. Biopsy with immunohistochemical analysis is helpful in difficult cases and has strong implications for patient management. TEACHING POINTS • FNHs are benign polyclonal neoplasms with no risk of haemorrhage or malignancy. • HCAs are benign monoclonal neoplasms classified into four subtypes based on immunohistochemistry. • Inflammatory HCAs show an atoll sign with a risk of bleeding and malignant transformation. • HNF-1α HCAs are steatotic HCAs with minimal complications and the best prognosis. • β-Catenin HCA shows variable MRI features and a high risk of malignancy.
Collapse
|
|
32
|
Pillon M, Carucci NS, Mainardi C, Carraro E, Zuliani M, Chemello L, Calore E, Tumino M, Varotto S, Toffolutti T, Destro R, Gazzola MV, Alaggio R, Basso G, Messina C. Focal nodular hyperplasia of the liver: an emerging complication of hematopoietic SCT in children. Bone Marrow Transplant 2015; 50:414-9. [PMID: 25581411 DOI: 10.1038/bmt.2014.276] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 09/26/2014] [Accepted: 10/23/2014] [Indexed: 12/16/2022]
Abstract
Hepatic focal nodular hyperplasia (FNH) is a nonmalignant condition rarely affecting children previously treated for cancer, especially those who received hematopoietic SCT (HSCT). Some aspects of its pathogenesis still remain unclear and a strong association with specific risk factors has not yet been identified. We report here a single institution's case series of 17 patients who underwent HSCT and were diagnosed with FNH, analyzing retrospectively their clinical features and the radiological appearance of their hepatic lesions. We aimed to compare the diagnostic accuracy of ultrasound (US) and magnetic resonance imaging (MRI) and to explore the role of transient elastography (FibroScan) to evaluate the degree of hepatic fibrosis in FNH patients. Our analysis showed an association of FNH with age at transplant ⩽12 years (hazard ratio (HR) 9.10); chronic GVHD (HR 2.99); hormone-replacement therapy (HR 4.02) and abdominal radiotherapy (HR 4.37). MRI proved to be a more accurate diagnostic tool compared with US. Nine out of 12 patients who underwent FibroScan showed hepatic fibrosis. Our study points out that FNH is an emerging complication of HSCT, which requires a lifelong surveillance to follow its course in cancer patients.
Collapse
Affiliation(s)
- M Pillon
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - N S Carucci
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - C Mainardi
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - E Carraro
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - M Zuliani
- Department of Radiology, University Hospital of Padova, Padova, Italy
| | - L Chemello
- Medicine Department-DIMED, University Hospital of Padova, Padova, Italy
| | - E Calore
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - M Tumino
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - S Varotto
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - T Toffolutti
- Department of Radiology, University Hospital of Padova, Padova, Italy
| | - R Destro
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - M V Gazzola
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - R Alaggio
- Pathology University of Padova, Padova, Italy
| | - G Basso
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - C Messina
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| |
Collapse
|
|
33
|
Tamura F, Kawano Y, Miyanishi K, Kubo T, Kamihara Y, Okagawa Y, Ishikawa K, Takada K, Hayashi T, Sato T, Sato Y, Kobune M, Takimoto R, Kawamoto M, Meguro M, Mizuguchi T, Ogino Z, Hasegawa T, Yoneda N, Sasaki M, Kato J. Multiple hepatocellular adenomas: a case report. KANZO 2015; 56:584-595. [DOI: 10.2957/kanzo.56.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2025]
Affiliation(s)
- Fumito Tamura
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine
| | - Yutaka Kawano
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine
| | - Koji Miyanishi
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine
| | - Tomohiro Kubo
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine
| | - Yusuke Kamihara
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine
| | - Yutaka Okagawa
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine
| | - Kazuma Ishikawa
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine
| | - Kohichi Takada
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine
| | - Tsuyoshi Hayashi
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine
| | - Tsutomu Sato
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine
| | - Yasushi Sato
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine
| | - Masayoshi Kobune
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine
| | - Rishu Takimoto
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine
| | - Masaki Kawamoto
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine
| | - Makoto Meguro
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine
| | - Toru Mizuguchi
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine
| | - Ziro Ogino
- Department of Clinical Pathology, Sapporo Medical University Hospital
| | - Tadashi Hasegawa
- Department of Clinical Pathology, Sapporo Medical University Hospital
| | - Norihide Yoneda
- Department of Radiology, Kanazawa University Graduate School of Medical Science
| | - Motoko Sasaki
- Department of Human Pathology, Kanazawa University Graduate School of Medical Science
| | - Junji Kato
- Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine
| |
Collapse
|
|
34
|
Schlageter M, Terracciano LM, D’Angelo S, Sorrentino P. Histopathology of hepatocellular carcinoma. World J Gastroenterol 2014; 20:15955-15964. [PMID: 25473149 PMCID: PMC4239483 DOI: 10.3748/wjg.v20.i43.15955] [Citation(s) in RCA: 164] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 05/09/2014] [Accepted: 07/22/2014] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is currently the sixth most common type of cancer with a high mortality rate and an increasing incidence worldwide. Its etiology is usually linked to environmental, dietary or life-style factors. HCC most commonly arises in a cirrhotic liver but interestingly an increasing proportion of HCCs develop in the non-fibrotic or minimal fibrotic liver and a shift in the underlying etiology can be observed. Although this process is yet to be completely understood, this changing scenario also has impact on the material seen by pathologists, presenting them with new diagnostic dilemmas. Histopathologic criteria for diagnosing classical, progressed HCC are well established and known, but with an increase in detection of small and early HCCs due to routine screening programs, the diagnosis of these small lesions in core needle biopsies poses a difficult challenge. These lesions can be far more difficult to distinguish from one another than progressed HCC, which is usually a clear cut hematoxylin and eosin diagnosis. Furthermore lesions thought to derive from progenitor cells have recently been reclassified in the WHO. This review summarizes recent developments and tries to put new HCC biomarkers in context with the WHOs reclassification. Furthermore it also addresses the group of tumors known as combined hepatocellular-cholangiocellular carcinomas.
Collapse
MESH Headings
- Animals
- Bile Duct Neoplasms/chemistry
- Bile Duct Neoplasms/classification
- Bile Duct Neoplasms/epidemiology
- Bile Duct Neoplasms/pathology
- Bile Ducts, Intrahepatic/chemistry
- Bile Ducts, Intrahepatic/pathology
- Biomarkers, Tumor/analysis
- Biopsy
- Carcinoma, Hepatocellular/chemistry
- Carcinoma, Hepatocellular/classification
- Carcinoma, Hepatocellular/epidemiology
- Carcinoma, Hepatocellular/pathology
- Cholangiocarcinoma/chemistry
- Cholangiocarcinoma/classification
- Cholangiocarcinoma/epidemiology
- Cholangiocarcinoma/pathology
- Diagnosis, Differential
- Humans
- Immunohistochemistry
- Liver Neoplasms/chemistry
- Liver Neoplasms/classification
- Liver Neoplasms/epidemiology
- Liver Neoplasms/pathology
- Neoplasm Grading
- Neoplasms, Complex and Mixed/chemistry
- Neoplasms, Complex and Mixed/classification
- Neoplasms, Complex and Mixed/epidemiology
- Neoplasms, Complex and Mixed/pathology
- Precancerous Conditions/chemistry
- Precancerous Conditions/classification
- Precancerous Conditions/epidemiology
- Precancerous Conditions/pathology
- Predictive Value of Tests
Collapse
|
|
35
|
Bioulac-Sage P, Sempoux C, Balabaud C. Immunohistochemical pitfalls in the diagnosis of focal nodular hyperplasia and inflammatory hepatocellular adenoma. Clin Res Hepatol Gastroenterol 2014; 38:245-9. [PMID: 24525010 DOI: 10.1016/j.clinre.2014.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/06/2014] [Accepted: 01/07/2014] [Indexed: 02/04/2023]
Affiliation(s)
- Paulette Bioulac-Sage
- Inserm U1053, Université Bordeaux Segalen, 33076 Bordeaux cedex, France; Service de Pathologie, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France.
| | - Christine Sempoux
- Service d'Anatomie pathologique, Cliniques Universitaires Saint-Luc, 1200 Bruxelles, Belgium
| | - Charles Balabaud
- Inserm U1053, Université Bordeaux Segalen, 33076 Bordeaux cedex, France
| |
Collapse
|
|
36
|
Hepatocellular adenomas in a large community population, 2000 to 2010: reclassification per current World Health Organization classification and results of long-term follow-up. Hum Pathol 2014; 45:976-83. [DOI: 10.1016/j.humpath.2013.12.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 12/15/2013] [Accepted: 12/23/2013] [Indexed: 12/30/2022]
|
|
37
|
Bioulac-Sage P, Chiche L, Balabaud C. Changes in the management of benign liver tumors. Clin Res Hepatol Gastroenterol 2013; 37:444-6. [PMID: 23948444 DOI: 10.1016/j.clinre.2013.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 06/18/2013] [Accepted: 06/26/2013] [Indexed: 02/04/2023]
Affiliation(s)
- Paulette Bioulac-Sage
- Service de Pathologie, Inserm U1053, Université Bordeaux Segalen, Hôpital Pèllegrin, 33076 Bordeaux cedex, France.
| | | | | |
Collapse
|
|
38
|
Guy J, Peters MG. Liver disease in women: the influence of gender on epidemiology, natural history, and patient outcomes. Gastroenterol Hepatol (N Y) 2013; 9:633-639. [PMID: 24764777 PMCID: PMC3992057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Women more commonly present with acute liver failure, autoimmune hepatitis, benign liver lesions, primary biliary cirrhosis, and toxin-mediated hepatotoxicity. Women less commonly have malignant liver tumors, primary sclerosing cholangitis, and viral hepatitis. There is a decreased rate of decompensated cirrhosis in women with hepatitis C virus infection, no survival difference in alcohol-related liver disease, and improved survival from hepatocellular carcinoma. In general, men are 2-fold more likely to die from chronic liver disease and cirrhosis than are women. Liver transplant occurs less commonly in women than in men, with variable disease outcomes based on etiology. This review highlights the epidemiology, natural history, treatment outcomes, and pathophysiology of common liver diseases in women and discusses how gender influences disease incidence, presentation, progression, and outcomes. Pregnancy-related liver disease is not covered.
Collapse
Affiliation(s)
- Jennifer Guy
- Dr Guy is the medical director of the Liver Cancer Program and a gastroenterologist in the Division of Hepatology at the California Pacific Medical Center in San Francisco, California. Dr Peters is chief of hepatology research and a professor of medicine at the University of California, San Francisco in San Francisco, California
| | - Marion G Peters
- Dr Guy is the medical director of the Liver Cancer Program and a gastroenterologist in the Division of Hepatology at the California Pacific Medical Center in San Francisco, California. Dr Peters is chief of hepatology research and a professor of medicine at the University of California, San Francisco in San Francisco, California
| |
Collapse
|