Beta catenin mutated hepatic adenomas are a genetic and pathologic subtype of hepatic adenoma. Their appearance and prognosis are different from 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
Beta catenin mutated hepatic adenomas 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 ref.
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 subtype is confirmed, the risk of malignant transformation to hepatocellular carcinoma is higher than with other subtypes, and follow-up should be performed according to hepatocellular carcinoma guidelines.
Differential diagnosis
- other types of hepatic adenoma
-
hepatocellular carcinoma (HCC)
- washout tends to leave the lesion hypointense compared to the 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
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