Histomorphological Profiles of Hepatocellular Adenoma: Diagnostic Insights and Challenges: A Retrospective Study of 10 Year Case Material

Introduction: Hepatocellular adenoma (HCA) is rare benign liver neoplasm. HCA can be single or multiple, and hepatic adenomatosis (HA) is defined as the occurrence of more than or equal to ten HCAs. Hepatocyte nuclear factor 1 alpha inactivated HCA (HHCA), Beta-catenin activated HCA (β HCA) Inflammatory HCA (IHCA), β catenin activated inflammatory adenoma (β IHCA) and Unclassified HCA (UHCA) are types based on correlation of genetic mutation and histological features.Materials and Methods: A 10 yrs retrospective study of HCA was done. Histological features scored as, 0, 1, 2 and 3. IHCA was diagnosed based on the presence of sinusoidal dilatation, pseudo portal tracts, and inflammatory infiltrate and any 2 or more features, with significant score were considered. β HCA was diagnosed on the any score of atypia, HHCA on the presence of steatosis with significant score and UHCA when no specific features were present. Glutamine synthetase (GS)/ β catenin stainingwas done.Results: There were 10 cases of HCA. 3 cases had more than 10 adenomas, most were well delineated (80%) and unencapsulated. There were 3 cases of HHCA, 1 of β HCA, 2 of IHCA, 2 of β IHCA and 2 of UHCA.Conclusions: Adenomas are rare liver neoplasm. The detection frequency of HA appears higher among HCA cases in India, thus further studies are essential. Though these tumors are reported to be non-capsulated, partial/complete capsule can be seen. Certain microscopic features help in classification, Immunohistochemistry/molecular testing is essential for exact typing and β catenin has low sensitivity in comparison to GS.