28 year old female with a 2.8 cm liver mass that was discovered incidentally. Per radiology report the liver mass demonstrate a T2 hyper intense signal. A needle core biopsy is performed and sent for pathology. Links to H&E and immunostains are below.
Final Diagnosis: Hepatic adenoma, inflammatory-type
The H & E slide shows several cores that consist of lesional tissue characterized by hepatic parenchyma showing areas of sinusoidal dilatation and scattered structures that have the appearance of inflamed portal tracts, but which in fact lack native bile ducts and instead show unpaired arteries and a peripheral bile ductular proliferation. The chronic inflammation focally spills into the lobules and there is also mild macrovesicular steatosis. Reticulin stain (not shown) highlights hepatic plates of normal thickness with no aberrant loss of staining. CK7 stain highlights the abnormal proliferation of bile ductules and occasional intact bile ducts within adjacent non-lesional hepatic tissue. The serum amyloid A stain is positive in the lesional tissue (and negative in the scant adjacent normal tissue), glutamine synthetase is diffusely weakly positive (showing no map-like staining and no strong diffuse staining) and LFABP is intact. The morphologic and immunophenotypic features support an inflammatory-type hepatic adenoma. Histologically, they are characterized by the presence of unpaired arteries with the absence of bile ducts with areas of inflammation. Serum amyloid A expression is a characteristic marker for inflammatory- type hepatic adenoma.
- Aurélie Beaufrère MD and Valérie Paradis, MD, PhD, Hepatocellular adenomas: review of pathological and molecular features, Human Pathology, Volume 112, June 2021, Pages 128 - 137.
- Aurélie Beaufrère MD and Valérie Paradis, MD, PhD, Hepatocellular adenomas: review of pathological and molecular features, PubMed.gov
This case is contributed by Dr.Zaid Mahdi M.D., Ph.D. Department of Pathology, Emory University Hospital.