Androgen-Induced, β-Catenin-Activated Hepatocellular Adenomatosis with Spontaneous External Rupture

Area of Science:

• Hepatology
• Oncology
• Endocrinology

Background:

• Androgens are known oncogenic agents, capable of inducing benign and malignant liver neoplasms, including hepatocellular adenoma (HCA) and hepatocellular carcinoma.
• The precise mechanisms underlying androgen-induced liver tumorigenesis remain incompletely understood.
• Androgen-induced liver tumors are typically solitary and asymptomatic until advanced stages.

Observation:

• A 24-year-old male with a history of testosterone undecanoate injections presented with fatigue, low libido, and diagnosed hepatocellular adenomatosis.
• He developed sudden, severe abdominal pain, found to be caused by a ruptured, bleeding hepatocellular adenoma (6.6 cm).
• Radiological imaging revealed multiple probable HCAs with significant hemoperitoneum, necessitating emergency management including transfusion and embolization.

Findings:

• Histopathological analysis of the liver biopsy showed atypical hepatocytes with specific molecular markers: nuclear beta-catenin and cytoplasmic glutamine synthetase.
• Tumor cells exhibited positive nuclear androgen receptor (AR) expression.
• No significant increase in EZH2 protein expression was observed in the tumor cells compared to normal hepatocytes.

Implications:

• This case underscores the importance of considering androgen-induced hepatocellular neoplasms in the differential diagnosis of acute abdominal presentations.
• The findings contribute to understanding the pathogenesis of androgen-related liver tumors.
• Early recognition and diagnosis are crucial for managing androgen-induced liver neoplasms, especially when complicated by rupture or hemorrhage.