title: Clinicopathological characteristics of serum amyloid A-positive hepatocellular neoplasms/nodules arising in alcoholic cirrhosis.
abstract: OBJECTIVE
  To characterize serum amyloid A (SAA)-positive hepatocellular neoplasms/nodules arising in alcoholic cirrhosis, which are detected as hypervascular hepatocellular nodules resembling hepatocellular carcinoma on imaging.
  
  
  RESULTS
  Fifty-three hepatocellular nodules were examined with immunostaining for SAA, glutamine synthetase and glypican-3 in 23 patients (four women and 19 men) with alcoholic cirrhosis. Sixteen nodules were examined with magnetic resonance imaging with gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid enhancement (EOB-MRI). Somatic mutations in IL6ST, GNAS and STAT3 were examined in 19 nodules. Thirty-six nodules in 18 patients were diagnosed as SAA-positive hepatocellular neoplasms/nodules, and the remaining 17 nodules in eight patients were SAA-negative focal nodular hyperplasia (FNH)-like nodules. SAA-positive hepatocellular neoplasms/nodules showed significantly more extensive sinusoidal dilatation, inflammatory reaction, abnormally thick arteries and cellular atypia than FNH-like nodules (P < 0.05). Eight SAA-positive hepatocellular neoplasms/nodules (67%) showed slight hypointensity in the hepatobiliary phase on EOB-MRI, whereas all four FNH-like nodules showed iso-intensity (P < 0.05). STAT3 mutations were detected in two of 17 SAA-positive hepatocellular neoplasms/nodules.
  
  
  CONCLUSIONS
  This study showed that approximately two-thirds of hypervascular hepatocellular nodules arising in alcoholic cirrhosis were SAA-positive hepatocellular neoplasms/nodules, which show different findings on the EOB-MRI. STAT3 mutations were detected in 11.8% of SAA-positive hepatocellular neoplasms/nodules, supporting a neoplastic nature.
authors.affiliation: Department of Human Pathology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.
authors.forename: Motoko
authors.initials: M
authors.lastname: Sasaki
authors.forename: Norihide
authors.initials: N
authors.lastname: Yoneda
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Sawai
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Imai
authors.forename: Fukuo
authors.initials: F
authors.lastname: Kondo
authors.forename: Toshio
authors.initials: T
authors.lastname: Fukusato
authors.forename: Seiichi
authors.initials: S
authors.lastname: Yoshikawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Sato
authors.forename: Osamu
authors.initials: O
authors.lastname: Matsui
authors.forename: Yasuni
authors.initials: Y
authors.lastname: Nakanuma
mesh_terms: D000328:Adult; D000368:Aged; D004252:DNA Mutational Analysis; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000175:diagnosis; D006801:Humans; D007150:Immunohistochemistry; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications*; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000235:genetics; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D000685:Serum Amyloid A Protein / Q000096:biosynthesis
chemical_list: D000685:Serum Amyloid A Protein
keywords: alcoholic cirrhosis; focal nodular hyperplasia; glutamine synthetase; hepatocellular carcinoma; inflammatory hepatocellular adenoma; serum amyloid A; serum amyloid A-positive hepatocellular neoplasm/nodule