Synchronous giant hepatic adenoma in siblings-A case report and brief literature review

Figures & data

Figure 1. Giant hepatic adenoma of the sister. (A) CT scan; clockwise from upper-left: Unenhanced scan, arterial phase of contrast enhanced scan, delayed phase of contrast enhanced scan, portal phase of contrast enhanced scan. (B) In situ hepatic adenoma. (C) View of resected hepatic adenoma. (D) Histology of resected hepatic adenoma.

Figure 2. Hepatic adenoma of the brother. (A) Magnetic Resonance imaging; clockwise from upper-left: T1-weighted image, T2-weighted image, fat suppressed image, diffusion weighted image. (B) In situ hepatic adenoma. (C) View of resected hepatic adenoma. (D) Histology of resected hepatic adenoma.

Figure 3. Subtype classification by immunohistochemical analysis. (A) The brother's HA; (B) The sister's HA. From upper panels to lower panels: LFABP, β-catenin, CRP and GS. All original magnifications are 100×; the magnification of the insets in β-catenin is 200× to show the sub-cellular distribution of the positive staining, and the magnification of the insets in GS is 40× to show the homogeneous or heterogeneous distribution of the positive staining.

Table 1. Phenotypic and molecular characteristics of four subgroups of hepatic adenoma

	HNF1α Mutated HA	β-Catenin Mutated HA
Molecular Characteristics	Germline	Somatic	Non-Mutated HA	Inflammatory	Non-Inflammatory
HNF1α Mutation	Yes, Germline	Yes, Somatic	No	No
Β-Catenin Mutation	No	Yes; Overexpressing Β-Catenin Target Genes	No
Inflammatory Infiltration	Infrequent	Less Frequent	Yes; Focal Or Diffuse	No
Morphological Features					No Specific
Steatosis	Marked Steatosis	Infrequent	Less Frequent
Pseudo-Glandular Formation	Less Frequent	Frequent	Infrequent
Cytological Abnormalities	Infrequent	Frequent	Frequent
Tumor	Larger, More Numerous	Smaller, Less Numerous	More Solitary	More Solitary
Clinical Features				No Specific
Connection With HCC	Infrequent	Significant	Infrequent
Age Of Patients	Younger	Elder	No Specific	No Specific
Oral Contraception History	Frequent	Less Frequent	Frequent	Frequent
Female Dominancy	Significant	Less Significant	Significant
Familiar Adenomatosis	Frequent	Less Frequent	No Specific	No Specific