Which molecular subtype of hepatocellular adenoma carries the highest risk of malignant transformation to hepatocellular carcinoma?
- A HNF1A-inactivated (steatotic) adenoma
- B Inflammatory (IL6/JAK-STAT pathway) adenoma
- C Beta-catenin activated adenoma ✓
- D Unclassified adenoma
Correct answer: C. Beta-catenin activated adenoma
Explanation
Beta-catenin activated adenomas show nuclear and pseudo-glandular atypia, glutamine synthetase overexpression, and carry the highest rate of malignant transformation, so they are resected even when small. The best distractor is the inflammatory adenoma, which instead carries the main risk of hemorrhage due to dilated sinusoids and arterialization. HNF1A-inactivated adenomas are multiple, steatotic, occur in maturity-onset diabetes of the young type 3, and have essentially no malignant potential.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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