Which histologic findings are characteristic of hepatocellular adenoma (HCA)?

Answer

Upon gross examination, hepatocellular adenomas appear as sharply circumscribed, light brown to yellow tumors that are soft in consistency and often lack a true fibrous tumor capsule.^[52]Although these lesions are usually solitary, hepatocellular adenomas may be multiple, with sizes ranging from 1 to 30 cm, although most are between 8 and 15 cm. Adenomas tend to be larger in women on OCPs. They also occur more frequently in the right lobe and are usually subcapsular, although pedunculated adenomas have also been described.

On microscopic examination, the hallmark of adenomas is the normal appearance of the hepatocytes. These are arranged in sheets and have no malignant features. These cells tend to be larger than normal hepatocytes, and their cytoplasm often contains fat or glycogen. (Their cytoplasm may appear relatively pale due to abundant glycogen stores when compared with normal hepatocytes). Generally, few, if any, portal tracts are present, and no central veins or bile ducts should be present.^[53]However, Bisceglia et al reported that subtypes of HAs may have CK7 positive ductules and are called hepatocellular adenoma with ductal/ductular differentiation.^[54]

Peliosis hepatis may occasionally be seen, and Kupffer cells are reduced in number or are absent.^[55]Vessels, when observed, tend to have thickened walls. Areas of thrombosis and infarction may be observed. Most hepatocellular adenomas contain a variable degree of microscopic collections of fat. Differentiation from a high-grade HCC can be difficult, if not impossible. Adenomas tend to lack malignant-appearing mitotic structures, the cell plates are generally only 2 cells thick, and no cellular infiltration (invasion) into the capsule or surrounding liver parenchyma occurs. Unfortunately, these features may also be seen in HCC, especially if it is well differentiated.

Hypervascularity is present upon the surface of the lesion. Because adenomas contain no portal vein branches, their blood supply is entirely arterial. The tendency for these lesions to bleed may be related to poor connective tissue support and their increased vasculature, which is made up of thin-walled, dilated sinusoids carrying blood at arterial pressure.

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Bradford A Whitmer, DO Fellow, Department of Gastroenterology, Providence Hospital

Bradford A Whitmer, DO is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Osteopathic Association

Disclosure: Nothing to disclose.

Coauthor(s)

Janice M Fields, MD, FACG, FACP Assistant Professor of Internal Medicine, Oakland University William Beaumont School of Medicine; Consulting Staff, Department of Internal Medicine, Section of Gastroenterology, Providence Hospital, St John Macomb-Oakland Hosptial

Janice M Fields, MD, FACG, FACP is a member of the following medical societies: American College of Gastroenterology, American College of Physicians-American Society of Internal Medicine, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, National Medical Association

Disclosure: Nothing to disclose.

Michael H Piper, MD Clinical Assistant Professor, Department of Internal Medicine, Division of Gastroenterology, Wayne State University School of Medicine; Consulting Staff, Digestive Health Associates, PLC

Michael H Piper, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Gastroenterology, American College of Physicians, Michigan State Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

Tushar Patel, MB, ChB Professor of Medicine, Ohio State University Medical Center

Tushar Patel, MB, ChB is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association

Disclosure: Nothing to disclose.

Acknowledgements

Brian S Berk, MD Assistant Professor, Department of Medicine, Dartmouth Medical School; Director of End Stage Liver Disease, Section of Gastroenterology, Dartmouth Hitchcock Medical Center

Brian S Berk, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, and American Gastroenterological Association

Disclosure: Nothing to disclose. Kenneth Ingram, PAC Assistant Professor, Department of Medicine, Division of Gastroenterology and Hepatology, Oregon Health and Science University School of Medicine

Disclosure: Nothing to disclose.

Sandeep Mukherjee, MB, BCh, MPH, FRCPC Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center

Disclosure: Merck Honoraria Speaking and teaching; Ikaria Pharmaceuticals Honoraria Board membership

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