Liver Cell Adenoma

 

Epidemiology:

    • rare
    • Young women of reproductive age (almost exclusively)
    • OCP
    • Anabolic steroids
    • Metabolic disorders:
      • Carbohydrate metabolic disorders – glycogen storage diseases I and IV
      • Galactosemia
      • Familial DM
      • Tyrosinemia
    • A liver lesion in cirrhosis should not be called adenoma unless regression is evident when the stimulus is removed, or if one of the risk factors above is present

 

Common sites:

    •  

 

Gross features:

    • Solitary usually
      • Multiple in multiple hepatocellular adenomatosis
    • pale yellow-tan
      • paler than background liver usually
    • bile stained frequently
    • often subcapsular
      • may be pedunculated
    • may be very large
    • well demarcated usually
      • may or may not have a capsule
      • round
    • hemorrhage and necrosis maybe
    • Background liver is normal or nearly normal

 

Histologic features:

    • plates 1-3 cells thick
      • pseudo-glandular architecture maybe
    • reticulin framework is intact or only focally decreased (important)
    • absent portal tracts
      • you can do CK7 to demonstrate this
    • prominent unaccompanied arterial vessels
    • uniform cell population
      • cells resemble normal hepatoctyes
      • similar size
      • n:c ratio similar
      • focal atypical or pleomorphic hepatocytes maybe
    • mitoses absent or rare
    • may have clear cytoplasm (glycogen)
    • Kupffer cells maybe
    • Fibrous bands not usually a feature
    • Lack of proliferativng bile ductules (as seen in FNH)
    • background liver is normal or nearly normal

 

Immunophenotype:

Marker:

Sensitivity:

Specificity:

CAM 5.2 

 

 

pCEA

 

 

CD34 (endothelial cells lining the cell plates)

 

 

AFP (neg)

 

 
    •  immunohistochemistry is not helpful to differentiate HA from HCC or FNH

 

 

Molecular features:

    •  

 

Other features:

    • regress on discontinuance of OCP
    • may grow during pregnancy
      • subcapsular adenomas may rupture, causing severe intraperitoneal hemorrhage
    • serum AFP normal or minimally elevated

 

References:

    • Robbins 2005
    • Lester’s Manual of Surgical Pathology
    • Odze RD, ed. (2004) Surgical Pathology of the GI Tract, Liver, Biliary Tract, and Pancreas.