A 34-year-old man taking anabolic steroids for bodybuilding has a 5 cm well-demarcated hepatic nodule without a fibrous capsule. Biopsy shows benign hepatocytes in plates one to two cells thick with unpaired arteries and no portal tracts. Molecular testing shows activation of beta-catenin. This lesion carries the greatest risk of which outcome?

• A Spontaneous regression after drug withdrawal
• B Progression to fibrolamellar carcinoma
• C Rupture with massive intraperitoneal hemorrhage
• D Malignant transformation to hepatocellular carcinoma ✓

Explanation

Beta-catenin activated hepatocellular adenoma has the highest rate of malignant transformation among adenoma subtypes and is overrepresented in men and in users of anabolic steroids; resection is recommended regardless of size. Inflammatory and HNF1-alpha inactivated adenomas carry low malignant risk and may regress after withdrawal of estrogen. Hemorrhage risk relates mainly to size and is not specific to this genotype. Fibrolamellar carcinoma is a distinct entity, not an adenoma endpoint.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.