Telangiectatic Variant of Hepatic Adenoma: Correlation between Liver Needle Biopsy and Resection.
Taofic Mounajjed, Tsung-Teh Wu. Mayo Clinic, Rochester
Background: Telangiectatic variant of hepatic adenoma (THA) is a benign hepatocellular neoplasm that requires surgical resection. Although the clinical and morphologic features of this entity are well characterized, the role of liver needle biopsy (LNB) in identifying this lesion prior to resection has not been studied in detail.
Design: We identified 52 patients (47 females & 5 males, 18-62 years) who have undergone resection of hepatic adenoma (HA) (31 patients), THA (14 patients) and focal nodular hyperplasia (FNH) (11 patients) following a LNB between 1994 and 2010. If lesions were multiple, we only included cases in which the targeted LNB site was specified and could be correlated with the resected lesion. We evaluated LNB and resection specimens for the following features: 1) abortive portal tracts 2) sinusoidal dilatation 3) ductular proliferation 4) inflammation 5) naked arteries 6) nodules, fibrous septa, and/or central stellate scar 7) steatosis. A diagnosis of HA or FNH was made according to established criteria. A diagnosis of THA was made if the lesion had all of the first 4 criteria (1-4) and lacked criterion 6.
Results: 25 patients had a single lesion (13 HA, 6 THA, 6 FNH) and 27 had multiple lesions (14 HA, 6 THA, 3 FNH, 2 HA & THA, 2 HA & FNH). Lesions ranged in size between 0.2 and 14.4cm, and when multiple, numbered between 2 and >100. All resection specimens diagnosed as THA met the first 4 criteria, lacked criterion 6, and contained naked arteries. Only 27% (8/30) of sampled THAs showed steatosis compared to 76% (51/67) of sampled HAs (p<0.0001). All resected HAs and FNHs were correctly diagnosed on LNB. Of the 14 patients receiving resection for THA, all diagnostic criteria for THA (except for inflammation in 1 patient) as well as naked arteries were present on LNB in 6 patients (42.8%). 4 patients (28.6%) had naked arteries only on LNB and lacked all the other criteria (except for sinusoidal dilatation in 1 patient). These were consistent with HA. The remaining 4 patients (28.6%) had some but not all features of THA on LNB (naked arteries & abortive portal tracts: 4/4, sinusoidal dilataion 2/4, ductular proliferation or inflammation: 0/4). No LNB of a THA was misdiagnosed as FNH.
Conclusions: Only 42.8% of resected THAs could be accurately diagnosed on LNB. However, more than half (57.2%) of resected THAs do not have complete diagnostic features on LNB and a subset (28.6%) is misclassified as HA. This is of no clinical consequence because it warrants adequate treatment. Importantly, No THA was misclassified as FNH on LNB. THA is significantly less likely to display steatosis than HA.
Category: Liver & Pancreas
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 204, Monday Morning