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Leberzelladenom

Entartungspotenzial und Abgrenzung vom hepatozellulären Karzinom

Hepatocellular adenoma: malignancy potential and differentiation from hepatocellular carcinoma

  • Schwerpunkt: Lebertumoren
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Zusammenfassung

Im Gegensatz zum hepatozellulären Karzinom (HCC) existierten bisher kaum molekularpathologische Untersuchungen des hepatozellulären Adenoms (HCA). Erkenntnisse zur Pathogenese liegen nur in Ansätzen vor. Besonders von chirurgischer Seite wird eine Operationsindikation wegen einer möglichen malignen Entartung des HCA gestellt. Die publizierten Fälle von Übergängen von HCA in ein HCC wurden auf der Basis heutiger morphologischer Standards neu evaluiert. Auch erfolgte ein Vergleich neuer molekularpathologischer Untersuchungen des HCA – vor allem Arbeiten eigener Arbeitsgruppen – mit denen des HCC. Die Ergebnisse sprechen dagegen, dass es sich bei typischen solitären HCA prämenopausaler Frauen um eine Vorläuferläsion des HCC handelt. Nach kritischer Revision der Literatur blieb nur eine Kasuistik eines Übergangs HCA/HCC unter einer heute nicht mehr üblichen Hormontherapie. Eine Abgrenzung besonderer HCA bei genetischen und Stoffwechselerkrankungen, Kindern, Männern, Adenomatosen und von HCA-artigen Tumoren bei bekannten Risikofaktoren des HCC erscheint sinnvoll. Bei den „klassischen“ HCA dagegen könnte die onkologische chirurgische Indikation entfallen. Voraussetzung ist eine histologische Abklärung, ggf. mit Unterstützung durch molekularpathologische Methoden.

Abstract

In contrast to hepatocellular carcinoma (HCC), very few molecular pathological studies have been carried out on hepatocellular adenoma (HCA). Particularly from the surgical point of view, based on views passed on verbally and in the literature of the 1970s and 1980s, a possible degeneration of the HCA provides grounds for operating. Published cases of transitions from HCA into HCC were evaluated on the basis of today’s morphological standards. A comparison was made between the patterns of new molecular pathological studies of HCA, above all the work of our own groups, and those of HCC. The results speak against the suggestion that a typical solitary HCA in pre-menopausal women is a precursor lesion of HCC. After a critical review of the literature, only one casuistic case of a transition of HCA to HCC under a hormone therapy, which is no longer practiced today, remained. A limitation of particular HCA in genetic and metabolic diseases, children, adult males, adenomatosis, and HCA-like tumors with known risk factors of HCC would seem pragmatically meaningful. With classic HCA, however, the oncological indication for surgery does not apply. A prerequisite is a histological clarification, if necessary with the support of molecular pathological methods.

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Authors and Affiliations

  1. Pathologisches Institut, Siemensplatz 4, 29223, Celle

    P. Flemming

  2. Institut für Pathologie, Medizinische Hochschule Hannover

    U. Lehmann & H. Kreipe

  3. Institut für Zell- und Molekularpathologie, Medizinische Hochschule Hannover

    L. Wilkens

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  1. P. Flemming
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  2. U. Lehmann
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  3. H. Kreipe
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  4. L. Wilkens
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Correspondence to P. Flemming.

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Flemming, P., Lehmann, U., Kreipe, H. et al. Leberzelladenom. Pathologe 27, 238–243 (2006). https://doi.org/10.1007/s00292-006-0835-0

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  • DOI: https://doi.org/10.1007/s00292-006-0835-0

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