Histopathology
October 21, 2026 · via Europe PMC
Identification and relevance of inter-tumour heterogeneity in hepatocellular adenoma according to subtypes and the context.
Bioulac-Sage P, Quaglia A, Schirmacher P, +7 more, Balabaud C.
AI summary — for doctors, generated from the abstract only
Multiple hepatocellular adenoma subtypes can coexist in one patient, and this rare pattern needs specialist care because of malignancy and bleeding risks.
What was studied
Case series of 26 patients with inter-tumour heterogeneity in hepatocellular adenoma, subtyped by immunohistochemistry and molecular analysis.
Key findings
- 22 of 26 had inflammatory HCA combined with another subtype.
- Most men (8 of 9) had underlying liver disease while none of the women did.
- One HNF1A adenomatosis had malignant transformation and one beta-catenin inflammatory case progressed to HCC; one sonic hedgehog HCA bled.
Clinical relevance
Subtype mix determines risk, so each nodule should be characterized rather than assuming one subtype.
Who should care
Limitations
Small descriptive series with no denominator or long-term follow-up for risk.
Refer patients with multiple adenomas to a tertiary center for subtype-specific assessment.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Introduction
Different molecular subtypes of hepatocellular adenoma (HCA) can occur at the same time within the same patient, defining inter-tumour heterogeneity (ITH). We describe a series of HCA-ITH cases, most identified in Bordeaux with additional cases contributed by other international centres.
Methods
ITH-HCA cases were subtyped by immunohistochemistry, confirmed by molecular analysis in most cases. The resulting diagnoses were HNF1A-HCA (H-HCA), inflammatory HCA (IHCA), b-catenin-mutated HCA (b-HCA) involving exon 3 or 7/8, b-catenin-mutated IHCA (b-IHCA) involving exon 3 or 7/8, sonic hedgehog HCA (sh-HCA) and unclassified HCA (UHCA).
Results
We identified 26 patients with ITH-HCA including 17 women; none had underlying liver disease, whereas most men did (8/9). The largest subgroup comprised 22 patients with IHCA combined with another subtype: H-HCA (five patients); H-HCA and b-IHCA-exon 3 borderline (one patient); b-IHCA-exon 3 (six patients); b-HCA and b-IHCA exon 3 (four patients); b-IHCA-exon7/8 (two patients); sh-HCA (three patients); UHCA (one patient). The remaining four patients had sh-HCA combined with UHCA (one patient) or b-IHCA ex3 (one patient), and 2 patients with HNF1A adenomatoses, one with malignant transformation, the other associated with a b-IHCA exon3 progressed to HCC. The largest nodule was a 13 cm IHCA. One of the sh-HCA presented with bleeding.
Conclusion
ITH-HCA covers the whole spectrum of the HCA classification. It is rare but poses significant clinical challenges, particularly in terms of identifying those lesions at risk of malignant transformation (b-HCA or b-IHCA exon 3) or bleeding (sh-HCA). Referral to a special tertiary centre is recommended.
DOI
10.1111/his.70298
PMID
42908052
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
Want more like this?
Browse more from the feed. A free account unlocks the full feed, saving and communities.
Back to the research feed