Inflammatory hepatocellular adenomas developed in the setting of chronic liver disease and cirrhosis

Mod Pathol. 2016 Jan;29(1):43-50. doi: 10.1038/modpathol.2015.119. Epub 2015 Oct 30.

Abstract

Hepatocellular adenoma is considered to occur exclusively in non-fibrotic livers. It is a heterogeneous entity and a molecular classification is now widely accepted. The most frequent hepatocellular adenoma subtype, namely inflammatory adenoma, harbor somatic activating mutations of genes involved in the interleukin-6 pathway that lead to high C-reactive protein and serum amyloid A expression. The aim of our study was to investigate a series of benign hepatocellular neoplasms developed on cirrhotic livers and characterized by an unequivocal histological diagnosis. We performed a clinical, pathological, and molecular study of 10 benign hepatocellular neoplasms developed in three patients with cirrhosis. Markers allowing hepatocellular adenoma classification were assessed by quantitative real-time PCR and immunohistochemistry. Samples were sequenced for CTNNB1, HNF1A, IL6ST, GNAS, STAT3, and TERT (promoter) mutations. A control series of 32 classical macronodules developed in cirrhosis related to various etiologies was screened by immunohistochemistry and gene sequencing. The three patients had cirrhosis related to metabolic syndrome and/or alcohol intake; two had a single tumor, while the third developed more than 30 lesions. Microscopic examination showed well-differentiated neoplasms sharing features with inflammatory adenoma including inflammatory infiltrates, sinusoidal dilatation, and dystrophic vessels. Sequencing revealed classical hotspot somatic mutations (IL6ST, n=8; STAT3, n=1; and GNAS, n=1) known to be responsible for IL-6/JAK/STAT pathway activation. Two classical high-grade macronodules demonstrated high serum amyloid A and/or C-reactive protein expression, without gene mutations. Altogether, our findings support the existence of rare inflammatory adenoma developed in cirrhosis.

MeSH terms

  • Adenoma, Liver Cell / complications
  • Adenoma, Liver Cell / genetics
  • Adenoma, Liver Cell / pathology*
  • Adult
  • Chromogranins
  • Cytokine Receptor gp130 / genetics
  • Cytokine Receptor gp130 / metabolism
  • End Stage Liver Disease / complications
  • End Stage Liver Disease / genetics
  • End Stage Liver Disease / pathology*
  • Female
  • GTP-Binding Protein alpha Subunits, Gs / genetics
  • GTP-Binding Protein alpha Subunits, Gs / metabolism
  • Hepatocyte Nuclear Factor 1-alpha / genetics
  • Hepatocyte Nuclear Factor 1-alpha / metabolism
  • Humans
  • Liver / metabolism
  • Liver / pathology*
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / genetics
  • Liver Cirrhosis / pathology*
  • Liver Neoplasms / complications
  • Liver Neoplasms / genetics
  • Liver Neoplasms / pathology*
  • Male
  • Middle Aged
  • Mutation
  • Promoter Regions, Genetic
  • STAT3 Transcription Factor / genetics
  • STAT3 Transcription Factor / metabolism
  • Telomerase / genetics
  • Telomerase / metabolism
  • beta Catenin / genetics
  • beta Catenin / metabolism

Substances

  • CTNNB1 protein, human
  • Chromogranins
  • HNF1A protein, human
  • Hepatocyte Nuclear Factor 1-alpha
  • IL6ST protein, human
  • STAT3 Transcription Factor
  • beta Catenin
  • Cytokine Receptor gp130
  • TERT protein, human
  • Telomerase
  • GNAS protein, human
  • GTP-Binding Protein alpha Subunits, Gs