title: Pigmented well-differentiated hepatocellular neoplasm with beta-catenin mutation.
abstract: According to the most recent WHO classification of hepatocellular adenomas, a small percentage of inflammatory hepatocellular adenomas presents with mutation in the beta-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 beta-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.
authors.affiliation: Institute of Liver Studies, King's College Hospital, Denmark Hill, SE5 9RS, London, UK. nigel.heaton@nhs.net.
authors.forename: Lara Neves
authors.initials: LN
authors.lastname: Souza
authors.forename: Rodrigo Bronze
authors.initials: RB
authors.lastname: de Martino
authors.forename: Richard
authors.initials: R
authors.lastname: Thompson
authors.forename: Sandra
authors.initials: S
authors.lastname: Strautnieks
authors.forename: Nigel D
authors.initials: ND
authors.lastname: Heaton
authors.forename: Alberto
authors.initials: A
authors.lastname: Quaglia
mesh_terms: D001654:Bile Pigments / Q000032:analysis*; D014408:Biomarkers, Tumor / Q000032:analysis*; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000737:chemistry / Q000235:genetics* / Q000473:pathology / Q000601:surgery; D002454:Cell Differentiation; D004252:DNA Mutational Analysis; D005260:Female; D020022:Genetic Predisposition to Disease; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000737:chemistry / Q000235:genetics* / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009154:Mutation; D010641:Phenotype; D051176:beta Catenin / Q000235:genetics*
chemical_list: D001654:Bile Pigments; D014408:Biomarkers, Tumor; C495270:CTNNB1 protein, human; D051176:beta Catenin