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Diffuse glutamine synthetase overexpression restricted to areas of peliosis in a β-catenin-activated hepatocellular adenoma: a potential pitfall in glutamine synthetase interpretation

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Abstract

Hepatocellular adenomas have recently been classified into four subtypes based on molecular findings: hepatocyte nuclear factor 1α (HNF1α) inactivated, inflammatory/telangiectatic, β-catenin activated, and unclassifiable. β-catenin-activated adenomas have the potential for malignant transformation and are thus important to recognize. Diffuse glutamine synthetase immunohistochemical positivity has been shown to be a reliable surrogate marker for β-catenin activation, though variations in staining patterns may be difficult to interpret. We report a case of a peliotic adenoma that was morphologically consistent with a β-catenin wild-type hepatocellular adenoma but harbored a β-catenin mutation by molecular analysis. The tumor lacked nuclear β-catenin positivity and demonstrated a hitherto undescribed pattern of glutamine synthetase overexpression restricted to areas of peliosis with mostly negative staining in non-peliotic areas. This pattern was initially interpreted as physiologic and may represent a potential pitfall in glutamine synthetase interpretation.

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The authors have no funding sources or conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM, 87131, USA

    Ryan S. Berry, Rama R. Gullapalli, Jin Wu & Joshua A. Hanson

  2. Department of Surgery, Division of Surgical Oncology, University of New Mexico School of Medicine, Albuquerque, NM, 87131, USA

    Katherine Morris

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  1. Ryan S. Berry
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  2. Rama R. Gullapalli
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  3. Jin Wu
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  4. Katherine Morris
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  5. Joshua A. Hanson
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Correspondence to Joshua A. Hanson.

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Berry, R.S., Gullapalli, R.R., Wu, J. et al. Diffuse glutamine synthetase overexpression restricted to areas of peliosis in a β-catenin-activated hepatocellular adenoma: a potential pitfall in glutamine synthetase interpretation. Virchows Arch 465, 241–245 (2014). https://doi.org/10.1007/s00428-014-1620-8

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  • DOI: https://doi.org/10.1007/s00428-014-1620-8

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