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Unexpected discovery of small HNF 1α ‐ inactivated hepatocellular adenoma in pathological specimens from patients resected for liver tumours
Author(s) -
Balabaud Charles,
Laurent Christophe,
Le Bail Brigitte,
Castain Claire,
Possenti Laurent,
Frulio Nora,
Chiche Laurence,
Blanc Jean Frédéric,
Bioulac Sage Paulette
Publication year - 2018
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13667
Subject(s) - hepatocellular adenoma , focal nodular hyperplasia , hepatocellular carcinoma , medicine , context (archaeology) , steatosis , adenoma , nodule (geology) , pathological , cholecystectomy , gastroenterology , pathology , biology , paleontology
Background and Aims It is rare but not uncommon to discover micro/small HNF 1α‐inactivated hepatocellular adenoma (H‐ HCA ) outside the context of resected H‐ HCA . We aimed to review our cases of micro/small H‐ HCA discovered by chance on different kinds of liver resected specimens. Methods We retrieved cases of micro/small H‐ HCA discovered by chance on resected specimens outside the context of H‐ HCA . All these nodules were liver fatty acid binding protein ( LFABP )‐negative contrasting with normal positivity in the surrounding non‐tumoural liver, ruling out the possibility of focal steatosis or other subtypes of micro‐ HCA s. Results We identified 19 micro/small H‐ HCA cases. In 16 cases they were discovered in patients who underwent surgery for benign nodules including one haemangioma, six focal nodular hyperplasia, seven inflammatory HCA (including one with b‐catenin activation), one HCA , whose subtype could not be identified because of massive necrosis/hemorrhage, and one hepatocellular carcinoma. In two additional cases, patients followed up for a melanoma underwent liver surgery to remove micro nodules possibly related to a metastatic process. Finally in one case a micro nodule was seen and resected during a cholecystectomy. Conclusion Taken together, H‐ HCA s are more frequent than we initially supposed as micro and small HCA s cannot all be detected by routine ultrasound. Despite no information on the potential growth of these micro/small H‐ HCA s, there is no argument to stop oral contraceptives or to ask for a specific regular surveillance. The association of different subtypes of HCA s with focal nodular hyperplasia suggests they share or have common etiological factors.