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Am J Clin Pathol. 2017 Jun 1;147(6):557-570. doi: 10.1093/ajcp/aqx010.

A Limited Immunohistochemical Panel Can Subtype Hepatocellular Adenomas for Routine Practice.

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From the Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles.
Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.



β-Catenin-activated hepatocellular adenomas have an elevated risk of harboring foci of hepatocellular carcinoma. Inflammatory adenomas also have an increased propensity for malignant transformation and are associated with a systemic inflammatory syndrome. Patients with these two adenoma subtypes benefit from excision. We assessed whether β-catenin-activated and inflammatory adenomas could be identified using a limited immunohistochemical panel.


Forty-six adenomas were assessed by morphology and β-catenin, serum amyloid A, and glutamine synthetase immunostains.


Morphologic examination produced a morphologic working diagnosis of inflammatory adenoma in 25 (54%) of 46 cases, β-catenin-activated adenoma in three (7%) of 46 cases, and 18 (39%) of 46 cases of other adenomas. After immunohistochemical staining, the morphologic diagnosis was confirmed in 15 (33%) of 46 and changed in 20 (43%) of 46, for a final distribution of 16 (35%) of 46 inflammatory adenomas, four (9%) of 46 β-catenin-activated adenomas, seven (15%) of 46 β-catenin-activated inflammatory adenomas, and 19 (41%) of 46 other adenomas.


Inflammatory and β-catenin-activated adenomas were readily identified by immunostaining patterns. These findings reinforce the necessity of immunohistochemistry in classifying adenomas, as assessing morphology alone often provided inaccurate subclassification. β-Catenin-activated and inflammatory adenomas can be accurately diagnosed using only a limited panel of widely available immunostains.


Amyloid A; Glutamine synthetase; Hepatocellular adenoma; Hepatocellular carcinoma; Immunohistochemistry; Inflammatory adenoma; Liver disease; Liver surgery; Liver tumor; β-Catenin

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