[Differential diagnosis of hepatic lesions associated to alterations of liver vascularization : regenerative nodules, adenomas or hepatocellular carcinoma ?]

Abstract

This work describes a case of hepatocellular adenoma with β-catenin mutated discovered during imaging follow-up of hyperplastic regeneration nodules in patient with cirrhosis due to a a Budd-Chiari syndrome. This case highlights the importance of using imaging protocols in the follow-up of patients with hepatic vascular diseases to identify adenomas at an early stage and differentiate them from large regenerative nodules, as well as to provide a complete immunohistochemical profile of all biopsied hepatocellular lesions. Indeed, since the early 2000s, the identification of genetic alterations associated with immuno-histochemical markers has allowed the classification of hepatocellular adenomas into six molecular subtypes. Each subtype presents different histological, clinical, radiological and evolutionary characteristics, all important for the management of the lesion. Furthermore, the risk of malignant transformation of an adenoma is not limited to the subtype β-mutated catenin, lesion size and male sex, but hepatic vascular disorders also appear to be another major risk factor.