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Hepatocellular Neoplasms Arising in Association With Androgen Use.

雄激素使用相关的肝细胞肿瘤

Gupta S,Naini BV,Munoz R,Graham RP,Kipp BR,Torbenson MS,Mounajjed T

Abstract

Correlation between androgen use and hepatocellular neoplasia is well established. However, there are no detailed studies of the histopathology and immunohistochemical/molecular profile of these tumors. We studied 9 patients with androgen-associated hepatocellular neoplasms. In addition to histology, immunostains for liver fatty acid-binding protein, β-catenin, glutamine synthetase, C-reactive protein, and serum amyloid A were utilized for tumor subtyping. Molecular testing using Solid Tumor Targeted Cancer Panel was performed on 3 cases. The neoplasms were predominantly seen in male individuals (7/9). Two patients (22%) had multifocal lesions. All lesions had architectural and 4/9 had cytologic atypia. Cholestasis was present in 6/9 cases. Reticulin was focally disrupted in 5/9 cases. Given the clinical setting, all lesions were classified as well-differentiated hepatocellular neoplasms of uncertain malignant potential. In cases with follow-up (6/9 cases, 67%), there were no recurrences or metastases. On the basis of the immunoprofile, 7 (78%) cases were β-catenin activated (including 1 hepatic adenoma with concurrent hepatocyte nuclear factor 1α inactivation) and 2 (22%) had inflammatory phenotype. Somatic mutations in CTNNB1 were detected in all 3 tested cases (all β-catenin activated by immunostain), all involving exon-3. Our data indicate that androgen-associated hepatocellular neoplasms most often develop in male individuals and always show some degree of atypia and/or focal reticulin disruption. Most are β-catenin activated, often harboring CTNNB1 exon-3 mutations, and a minority is inflammatory type. Although β-catenin and inflammatory pathways likely play a role in pathogenesis, the heterogenous molecular profile suggests there are other (yet to be characterized) primary oncogenic mechanisms in this unique tumor type.

摘要

雄激素的使用和肝细胞瘤相关早已明确。但是这类肿瘤的组织病理学和免疫组织化学特点还没有详尽研究。

我们对9例雄激素相关肝细胞肿瘤进行了组织学以及免疫组化分析(包括肝脏脂肪酸结合蛋白、β-catenin、谷氨酰胺合成酶、C反应蛋白、血清淀粉样蛋白A等)。其中3例用实体瘤癌症靶向检测方案进行分子检测。

结果:雄激素相关的肝细胞肿瘤主要见于男性(7/9)。两名患者(22%)为多灶病变。所有病变均有结构异型性,4例有细胞异型性。6例有胆汁淤积。5例有网状蛋白的局灶表达缺失。根据患者的临床表现,这些肿瘤为恶性潜能不确定的高分化肝细胞肿瘤。随访了6例(67%),没有复发或转移。免疫组化显示,7例(78%)有β-catenin活化(包括1例同时有肝细胞核因子1α灭活的肝腺瘤),2例(22%)有炎性浸润。免疫组化有β-catenin染色活化的3例中,均检测到CTNNM1的体细胞突变,均与3号外显子有关。

本研究表明,雄激素相关的肝细胞肿瘤最常见于男性,具有一定程度的细胞异型性和/或网状蛋白局灶缺失。这些肿瘤大部分有β-catenin的激活,常具有CTNNB1的3号外显子突变,少数肿瘤为炎症类型。虽然我们的结果提示β-catenin和炎症通路可能在这些肿瘤发病中发挥作用,但这些肿瘤的分子异质性表明还有其他未明致瘤机制的参与。


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