Beta catenin mutated hepatic adenoma
Beta catenin mutated hepatic adenomas are a genetic and pathologic subtype of hepatic adenoma. Their appearance and prognosis are different than other subtypes.
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Epidemiology
They are the least common subtype of hepatic adenoma (10-15%). They occur more frequently in men and are associated with male hormone administration, glycogen storage disease, and familial adenomatous polyposis (FAP).
Clinical presentation
May develop right upper quadrant pain from intratumoural hemorrhage.
Radiographic features
The appearance of this subtype overlaps the appearance of other subtypes. No distinctive imaging features have yet been identified.
Treatment and prognosis
If imaging shows a hepatic adenoma, then patients usually stop hormones administration, and the lesions regress ref required.
If it does not regress, then one treatment pathway suggests:
- ≥5 cm: resection (hepatic adenomas larger than 5 cm are at increased risk of hemorrhage)
- <5 cm: biopsy
Tissue diagnosis then confirms or changes the adenoma subtype. If beta-catenin mutated pathologic subtype, then the risk of malignant transformation to hepatocellular carcinoma is higher than with other subtypes, and follow-up should be according to HCC guidelines.
Differential diagnosis
- other types of hepatic adenoma
- inflammatory hepatic adenoma
- HNF 1alpha mutated hepatic adenoma
- unclassified hepatic adenoma
-
hepatocellular carcinoma (HCC)
- washout tends to leave the lesion hypointense c.f. to rest of liver
- different demographics
- may be difficult to distinguish if well differentiated 7
- focal nodular hyperplasia (FNH)
- liver metastases (hypervascular)
- for other differential considerations, see the main article: hepatic adenoma
Related Radiopaedia articles
Hepatobiliary pathology
- depositional disorders
- infection and inflammation
- liver abscess
- hepatic hydatid infection
- cirrhosis
- hepatitis
- cholecystitis
- cholangitis
- malignancy
- liver and intrahepatic bile duct tumors
- benign epithelial tumors
- hepatocellular hyperplasia
- hepatocellular adenoma
- hepatic/biliary cysts
- benign nonepithelial tumors
- primary malignant epithelial tumors
- hepatocellular carcinoma
- hepatocellular carcinoma variants
- cholangiocarcinoma
- biliary cystadenocarcinoma
- combined hepatocellular and cholangiocarcinoma
- hepatoblastoma
- undifferentiated carcinoma
- primary malignant nonepithelial tumors
- hematopoietic and lymphoid tumors
- primary hepatic lymphoma
- hepatic myeloid sarcoma (hepatic chloroma)
- secondary tumors
- miscellaneous
- adrenal rest tumors
- hepatic carcinosarcoma
- hepatic fibroma
- hepatic Kaposi sarcoma
- hepatic lipoma
- hepatic mesenchymal hamartoma
- hepatic myxoma
- hepatic rhabdoid tumor
- hepatic solitary fibrous tumor
- hepatic teratoma
- hepatic yolk sac tumor
- inflammatory myofibroblastic tumor (inflammatory pseudotumor)
- nodular regenerative hyperplasia
- pancreatic rest tumors
- primary hepatic carcinoid
- benign epithelial tumors
- extrahepatic bile duct tumors
- extrahepatic bile duct cholangiocarcinoma
- hilar cholangiocarcinoma (Klatskin tumor)
- extrahepatic bile duct cholangiocarcinoma
- liver and intrahepatic bile duct tumors
- metabolic
- trauma
- vascular
- portal venous gas
- portal hypertension
- portal vein thrombosis
- arterioportal shunts
- hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)
- Budd-Chiari syndrome
- passive hepatic congestion
- hepatic veno-occlusive disease
- hepatic infarction
- peliosis hepatis
- hepatic venous malformations (hemangiomas)
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