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Pigmented well-differentiated hepatocellular neoplasm with beta-catenin mutation |
Lara Neves Souza, Rodrigo Bronze de Martino, Richard Thompson, Sandra Strautnieks, Nigel D Heaton and Alberto Quaglia |
London, UK
Author Affiliations: Institute of Liver Studies, King's College Hospital, Denmark Hill, SE5 9RS, London, UK (Neves Souza L, de Martino RB, Thompson R, Strautnieks S, Heaton ND and Quaglia A); Department of Gastroenterology, Discipline of Liver and Gastrointestinal Transplantation, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil (de Martino RB)
Corresponding Author: Nigel D Heaton, Professor, Institute of Liver Studies, King's College Hospital, Denmark Hill, SE5 9RS, London, UK (Tel: +44770234801; Fax: +44232993575; Email: nigel.heaton@nhs.net) |
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Abstract According to the most recent WHO classification of hepatocellular adenomas, a small percentage of inflammatory hepatocellular adenomas presents with mutation in the β-catenin gene and are at higher risk of malignant transformation. It has been recognized that adenoma-like hepatocellular neoplasms with focal atypia, or in unusual clinical context present with similar cytogenetic and immunohistochemistry characteristics to well-differentiated hepatocellular carcinomas. We report a case of a well-differentiated hepatocellular neoplasm with Dubin-Johnson-like pigment displaying histological features overlapping with a β-catenin mutated inflammatory adenoma and a well-differentiated hepatocellular carcinoma in a non-cirrhotic liver. The patient was a 48-year-old woman, who was asymptomatic, and had a clinical history of intra-uterine exposure to diethylstilbestrol, previous cancers and past oral contraceptive use. The recently proposed term "well-differentiated hepatocellular neoplasm of uncertain malignant potential" should be applied in such cases to highlight the different pathogenesis and risk of malignancy compared to the typical adenomas, and to suggest a careful and customized clinical management.
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