Among the molecular subtypes of hepatic adenoma, which one carries the highest risk of malignant transformation to hepatocellular carcinoma?

• A HNF1-alpha inactivated adenoma
• B Beta-catenin activated adenoma ✓
• C Inflammatory (telangiectatic) adenoma
• D Sonic hedgehog subtype adenoma

Explanation

Beta-catenin activated adenomas carry activating mutations of the CTNNB1 gene, placing them on the same Wnt signaling pathway dysregulated in hepatocellular carcinoma, and they show the greatest risk of transformation, particularly in men and in users of anabolic steroids. HNF1-alpha inactivated tumors, the most common subtype, are linked to maturity-onset diabetes of the young type 3 and carry essentially no malignant risk. Inflammatory adenomas, formerly called telangiectatic, are driven by IL-6 and STAT3 activation and mainly risk hemorrhage. Resection is advised for beta-catenin positive lesions regardless of size.

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.