A 31-year-old woman who has taken combined oral contraceptives for 8 years undergoes resection of a 7 cm hemorrhagic liver tumor that presented with hemoperitoneum. Pathology confirms hepatocellular adenoma. Molecular subtyping is performed. Which subtype carries the highest risk of malignant transformation?

• A Beta-catenin activated subtype ✓
• B Inflammatory (IL6/JAK-STAT pathway) subtype
• C HNF1A-inactivated subtype
• D Unclassified subtype

Explanation

Beta-catenin activated adenomas carry the highest risk of transformation to hepatocellular carcinoma, often show cytologic atypia, and typically arise in men or in adenomas larger than 5 cm; they warrant resection. HNF1C-inactivated adenomas, linked to hepatocyte nuclear factor 1alpha germline mutations and multiple lesions, have a very low malignant risk. Inflammatory adenomas carry bleeding risk related to sinusoidal dilatation rather than malignancy.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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