Hepatocellular adenoma in men: A nationwide assessment of pathology and correlation with clinical course

on behalf of the Dutch Benign Liver Tumor Group and the PALGA group

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Background & Aims: Hepatocellular adenomas (HCA) rarely occur in males, and if so, are frequently associated with malignant transformation. Guidelines are based on small numbers of patients and advise resection of HCA in male patients, irrespective of size or subtype. This nationwide retrospective cohort study is the largest series of HCA in men correlating (immuno)histopathological and molecular findings with the clinical course. Methods: Dutch male patients with available histological slides with a (differential) diagnosis of HCA between 2000 and 2017 were identified through the Dutch Pathology Registry (PALGA). Histopathology and immunohistochemistry according to international guidelines were revised by two expert hepatopathologists. Next generation sequencing (NGS) was performed to confirm hepatocellular carcinoma (HCC) and/or subtype HCA. Final pathological diagnosis was correlated with recurrence, metastasis and death. Results: A total of 66 patients from 26 centres fulfilling the inclusion criteria with a mean (±SD) age of 45.0 ± 21.6 years were included. The diagnosis was changed after expert revision and NGS in 33 of the 66 patients (50%). After a median follow-up of 9.6 years, tumour-related mortality of patients with accessible clinical data was 1/18 (5.6%) in HCA, 5/14 (35.7%) in uncertain HCA/HCC and 4/9 (44.4%) in the HCC groups (P =.031). Four B-catenin mutated HCA were identified using NGS, which were not yet identified by immunohistochemistry and expert revision. Conclusions: Expert revision with relevant immunohistochemistry may help the challenging but prognostically relevant distinction between HCA and well-differentiated HCC in male patients. NGS may be more important to subtype HCA than indicated in present guidelines.

Original languageEnglish
Pages (from-to)2474-2484
Number of pages11
JournalLiver International
Issue number10
Publication statusPublished - Oct 2021

Bibliographical note

Funding Information:
The study was supported by a personal grant of the Amsterdam UMC, location AMC to B. V. van Rosmalen. For the remaining authors, none were declared. The research was not preregistered in an independent, institutional registry. Collaborators on behalf of the Dutch Benign Liver Tumor Group: Amsterdam UMC, Location AMC (University of Amsterdam), Amsterdam: Dr J I Erdmann (surgeon), T G J M Dirksen (technician histopathology); Deventer Hospital, Deventer: Dr H Torrenga (surgeon); Amphia Hospital, Breda: Dr P D Gobardhan (surgeon); Diakonessenhuis Hospital, Utrecht: Dr L van Huis-Tanja (oncologist), Dr Smakman (surgeon); Leiden University Medical Center, Leiden: Dr A Inderson (gastroenterologist), Prof. Dr B van Hoek (gastroenterologist); Maasstad Hospital, Rotterdam: Dr M C Buis (gastroenterologist); Northwest Clinics, Location Alkmaar, Alkmaar: Dr A P J Houdijk (surgeon); OLVG Hospital, Location Oost, Amsterdam: Dr H A Marsman (surgeon); Gelderse Vallei Hospital in Ede: Dr C Sietses (surgeon); University Medical Center Groningen: Prof. Dr A S H Gouw (pathologist).

Publisher Copyright:
© 2021 The Authors. Liver International published by John Wiley & Sons Ltd.


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