Steatotic hepatocellular adenomas with different phenotypic subtypes: a case report

Hepatocellular adenomas (HCAs) are heterogeneous group of benign tumors; three pathomolecular subtypes have been identified so far: hepatocyte nuclear factor 1 α-inactivated HCA (H-HCA) (35-40%), inflammatory HCA (I-HCA) (>50%), β-catenin activated HCA (10%). Ten percent of I-HCA are also β-catenin activated. We report a rare case of three histologically confirmed steatotic HCAs of three different phenotypes: I-HCA, β-catenin activated I-HCA, and H-HCA in a 36-year-old woman. This observation outlines that in the same patient, HCA may be of different subtypes. The predisposition to develop different HCA hypothetically caused by a "benign tumorigenic field effect" may result, even rarely, in different genotypes/phenotypes such as H-HCA and I-HCA. Moreover, we illustrate the very high specificity of MR for subtyping HCA.