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β-Catenin-activated inflammatory hepatocellular adenoma with pigmentation and atypical features: a case report

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Abstract

Hepatocellular adenomas are rare diseases, defined as benign liver neoplasms composed of cells with hepatocellular differentiation. Differential diagnosis of hepatocellular adenoma from other lesions, including focal nodular hyperplasia and hepatocellular carcinoma, is crucial to determine treatment strategy. We describe a case of β-catenin-activated inflammatory hepatocellular adenoma with malignant transformation. A 50-year-old man with a suspected liver tumor, based on abdominal ultrasonography findings, was referred to our hospital. Contrast-enhanced computed tomography and magnetic resonance imaging revealed a liver tumor in S2 which was enhanced in the arterial phase to the delayed phase. Based on diagnostic imaging findings, hepatocellular adenoma or focal nodular hyperplasia was suspected. We considered the possibility of malignant potential because of the enlargement of the lesion. Thus, we performed a laparoscopic hepatectomy. Histological examination showed pigment deposition in the hepatocytes, which was determined to be lipofuscin. Mild nuclear swelling and atypia in the tumor area indicated nodular growth. Based on the histological and immunohistochemical findings, the diagnosis was ꞵ-catenin-activated inflammatory hepatocellular adenoma with atypical features. The imaging features of hepatocellular adenoma and focal nodular hyperplasia are similar, but if the tumor tends to grow, surgical treatment should be performed because of the possibility of malignant hepatocellular adenoma.

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Data availability

All data generated or analyzed during this study are included in this article.

Abbreviations

AFP:

α-Fetoprotein

b-HCA:

ꞵ-Catenin-activated hepatocellular adenoma

b-IHCA:

β-Catenin-activated inflammatory hepatocellular adenoma

CRP:

C-reactive protein

CT:

Computed tomography

FNH:

Focal nodular hyperplasia

Gd-EOB-DTPA:

Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid

GS:

Glutamine synthetase

HCA:

Hepatocellular adenoma

HCC:

Hepatocellular carcinoma

HNF1a:

Hepatocyte nuclear factor 1a

H-HCA:

HNF1A-inactivated hepatocellular adenoma

IHCA:

Inflammatory hepatocellular adenoma

MRI:

Magnetic resonance imaging

OATP:

Organic anion transporting polypeptide

SAA:

Serum amyloid A

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Acknowledgements

We would like to thank Dr. Yasuni Nakanuma at Fukui Saiseikai Hospital (Fukui, Japan) and all staff members at Aomori City Hospital (Aomori, Japan) for their contribution to this report.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of General Surgery, Aomori City Hospital, 1-14-20, Katta, Aomori, 030-0821, Japan

    Yusuke Wakasa, Yoshikazu Toyoki, Yuma Kameyama, Tadashi Odagiri, Hiroyuki Jin, Makoto Nakai, Kazunori Aoki, Hiroaki Kawashima & Masaaki Endo

  2. Department of Pathology, Aomori City Hospital, Aomori, Japan

    Tomomi Kusumi

Authors
  1. Yusuke Wakasa
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  2. Yoshikazu Toyoki
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  3. Tomomi Kusumi
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  4. Yuma Kameyama
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  5. Tadashi Odagiri
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  6. Hiroyuki Jin
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  7. Makoto Nakai
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  8. Kazunori Aoki
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  9. Hiroaki Kawashima
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  10. Masaaki Endo
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Contributions

YW wrote the manuscript. YT managed the clinical practice and authored the case study. TK supervised the pathological examinations in the study. YK, TO, HJ, MN, KA, and HK provided advice on the manuscript. YT and ME supervised the clinical practice.

Corresponding author

Correspondence to Yusuke Wakasa.

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Conflict of interest

The authors have no competing interests to declare.

Human and animal rights

This case report was conducted in accordance with the Declaration of Helsinki. The Aomori City Hospital Ethics Committee (Aomori, Japan) approved the study protocol.

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The patient provided consent for this case report to be published.

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Wakasa, Y., Toyoki, Y., Kusumi, T. et al. β-Catenin-activated inflammatory hepatocellular adenoma with pigmentation and atypical features: a case report. Clin J Gastroenterol 16, 237–243 (2023). https://doi.org/10.1007/s12328-023-01757-2

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  • DOI: https://doi.org/10.1007/s12328-023-01757-2

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