J Pathol Transl Med.  2018 Jul;52(4):226-231. 10.4132/jptm.2017.11.12.

Hepatocellular Carcinoma Arising in a Huge Hepatocellular Adenoma with Bone Marrow Metaplasia

• Kang HJ
• Jeong HJ
• Kim SW
• Yu E
• Lee YJ
• Kim SY
• Kim J

• KMID: 2417806
• DOI: http://doi.org/10.4132/jptm.2017.11.12

Abstract

Hepatocellular adenoma (HCA) is the most common type of benign liver tumor, and its major complication is malignant transformation to hepatocellular carcinoma (HCC). Here, we report a case of HCC arising in HCA with bone marrow metaplasia in a 24-year-old Korean woman who presented with abdominal discomfort. A huge liver mass was found on abdominal ultrasonography. She underwent surgical hepatic resection, and the resected specimen was entirely involved by a 20-cm-sized tumor. Histological review revealed a well differentiated HCC arising from inflammatory HCA with β-catenin nuclear positivity and bone marrow metaplasia that contained hematopoietic cells. This case was unique because malignant transformation, inflammatory type HCA, β-catenin nuclear staining, and bone marrow metaplasia were simultaneously observed. Additionally, it should be noted that a large HCA with β-catenin activation can undergo malignant transformation and should be surgically resected in a timely manner.

Keyword

Carcinoma, hepatocellular; Adenoma, liver cell; Bone marrow metaplasia; β-catenin

MeSH Terms

Adenoma, Liver Cell*
Bone Marrow*
Carcinoma, Hepatocellular*
Female
Humans
Liver
Metaplasia*
Ultrasonography
Young Adult

Figure

• 

  Fig. 1. Imaging and gross pathological findings. (A) Dynamic liver and pelvis computed tomography shows an enlarged liver with a huge, well-defined, hypervascular mass in segments 4, 5, and 8 of the liver during arterial phase. (B) The surface of a slice from a surgically resected specimen reveals a heterogeneously yellow-brown color and multinodular growth with partly cystic degeneration that contained hemorrahge and necrosis.

• 

  Fig. 2. Microscopic and immunohistochemical findings of hepatocellular adenoma (HCA), inflammatory type with β-catenin activation (A–F) and hepatocellular carcinoma (HCC) (G–L). (A) Dilated sinusoids and intratumoral inflammation in the portal tract-like areas are observed in the parenchyma. (B) Large aberrant arteries with infiltration of variable inflammatory cells including lymphocytes, neutrophils, and eosinophils are occasionally observed. Tumor cells show diffuse cytoplasmic expression of serum amyloid A (C), C-reactive protein (D), and glutamine synthetase (E). (F) Nuclear β-catenin expression (arrows) is observed in several tumor cells. (G) Nuclear atypia and thick trabeculae are observed in the HCC component. (H) Heat shock protein-70 is strongly and diffusely positive. (I) Glypican 3 is partially positive. (J) Loss of reticulin is observed in the HCC component, whereas reticulin staining is preserved in the HCA (inset). (K) CD34 expression on sinusoidal cells is strong and diffuse in HCC but is patchy in HCA (inset). (L) The Ki-67 labeling index of the HCC area is significantly increased compared with that of HCA (inset).

• 

  Fig. 3. Histological findings of bone marrow metaplasia. (A) Bone marrow metaplasia is observed in the inner hepatocellular adenoma. (B, C) Bone marrow metaplasia is characterized by mature lamellar bone that formed trabeculae intermingled with fat tissue containing erythroblasts, myeloblasts, and megakaryocytes. (D) Tumor cells near the bone marrow metaplasia shows positivity for epithelial cell adhesion molecule immunohistochemical staining.

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