A 32-year-old woman taking combined oral contraceptive pills presents with sudden hypotension and right upper quadrant pain. CT shows a 7 cm liver mass with hemoperitoneum. Emergency partial hepatectomy is performed. Histology shows plates of benign-appearing hepatocytes with steatosis, thick-walled unpaired arteries, and no portal tracts. Which feature of this tumor determines its risk of malignant transformation?
- A Presence of steatosis within the tumor
- B Beta-catenin activation mutation ✓
- C Size greater than 5 cm
- D Inflammatory infiltrate with sinusoidal dilatation
Explanation
Hepatocellular adenomas are subclassified molecularly: HNF1A-inactivated (steatotic), inflammatory (telangiectatic), beta-catenin activated, and unclassified. Only the beta-catenin activated subtype carries significant risk of transformation to hepatocellular carcinoma and warrants resection even when small. Size above 5 cm predicts bleeding risk and prompts resection, but it is not the marker of malignant potential. Steatosis defines the HNF1A subtype, which has an excellent prognosis, and inflammation defines the inflammatory subtype associated with obesity and GNAS mutations.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.