Clinicopathological Characteristics of Serum Amyloid A-Positive Hepatocellular Neoplasms Arising in Advanced Alcoholic Liver Disease
Motoko Sasaki, Norihide Yoneda, Yasunori Sato, Osamu Matsui, Yasuni Nakanuma. Kanazawa University Graduate School of Medicine, Kanazawa, Japan
Background: Hypervascular hepatocellular nodular lesions resembling hepatocellular carcinoma are sometimes detected by imaging modality in patients with alcoholic cirrhosis. Herein, forty-eight hepatocellular nodules were characterized in 19 patients (2 women and 17 men, age ranged 40-67 yrs) with alcoholic cirrhosis.
Design: Nineteen patients were retrieved from our pathological files (1997-2012). The hepatocellular nodules were multiple (>3) in 15 patients. The immunoreactivity for serum amyloid A, glutamine synthetase (GS) and glypican-3 was examined in 48 hypervascular hepatocellular nodules. Fourteen hepatocellular nodules were examined on the magnetic resonance (MR) imaging with gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB) enhancement.
Results: Thirty-two nodules (4-35mm in diameter, mean±SD, 13.0± 7.5mm) in 14 patients (2 women and 12 men, age ranged 40-67 yrs) were diagnosed as serum amyloid A-positive hepatocellular neoplasm, which shares features with inflammatory hepatocellular adenoma (Sasaki M, et al. Modern Pathol 2012). The remaining sixteen nodules (5-25mm, mean±SD, 10.2± 4.3mm) in 7 patients (a woman and 6 men, age ranged 41-62 yrs) were focal nodular hyperplasia (FNH)-like nodules. The FNH-like nodules showed no immunoreactivty for serum amyloid A and a map-like staining pattern of GS. Two patients had both serum amyloid A-positive hepatocellular neoplasms and FNH-like nodules. The serum amyloid A -positive hepatocellular neoplasms showed increased cellular density, sinusoidal dilatation, inflammatory infiltrate and ductular reaction to various degrees. These histologic features tended to be less extensive in FNH-like nodules. The serum amyloid A -positive hepatocellular neoplasms and FNH-like nodules did not show an overexpression of GS and the immunoreactivity for glypican-3. Seven of 11 serum amyloid A-positive hepatocellular neoplasms showed hypointensity in the hepatobiliary phase on the MRI with Gd-EOB enhancement, similarly to hepatocellular carcinoma. In contrast, 3 FNH-like nodules showed iso-intensity in the hepatobiliary phase.
Conclusions: This study further confirmed characteristics of serum amyloid A-positive hepatocellular neoplasm arising in alcoholic cirrhosis that share features with inflammatory hepatocellular adenomas. Serum amyloid A-positive hepatocellular neoplasms sometimes co-exist with FNH-like nodules and may show different findings on Gd-EOB enhanced MR imaging.
Monday, March 4, 2013 1:45 PM
Proffered Papers: Section E, Monday Afternoon