Beta catenin mutated hepatic adenoma

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Beta catenin mutated hepatic adenomas are a genetic and pathologic subtype of hepatic adenoma. Their appearance and prognosis are different than other subtypes.

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 intratumoral 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 .

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