Changing trends in malignant transformation of hepatocellular adenoma
Changing trends in malignant transformation of hepatocellular adenoma
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DOI：
10.1136/gut.2010.222109
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发表时间：
2011-01-01
期刊：
影响因子：
24.5
通讯作者：
Paradis, Valerie
中科院分区：
文献类型：
--
作者：
Farges, Olivier;Ferreira, Nelio;Paradis, Valerie
目的肝细胞腺瘤（HCAs）通常发生于服用口服避孕药的女性，并有恶性转化为肝细胞癌（HCC）的风险。然而，HCA恶变是一个定义不清的实体，被认为是HCC的一个轶事途径。本研究的目的是探讨HCA中发生的恶性肿瘤。设计、设置和患者一系列组织学证实的HCA在1993年至2008年期间在三级肝胆中心进行管理（218例患者，184名妇女和34名男子）主要观察指标分析整个研究期间HCA恶变的发生率并检索了相关条件。结果在23例患者中观察到HCA内的HCC区域，女性恶性转化的风险为4%，男性为47%。在研究期间，HCA发生恶变的女性人数保持稳定，口服避孕药是唯一的相关条件。自2000年以来，患有这种转变的男性人数显着增加，代谢综合征已成为最常见的相关疾病。三分之二的HCA恶性转化是β-连环蛋白激活的，三分之一显示细胞凋亡。这两种特征在男性中更为普遍。HCA恶性肿瘤的中位直径为10 cm，仅3例直径小于5 cm。结论HCA中恶性肿瘤的患病率男性是女性的10倍，HCA的治疗应主要基于性别。口服避孕药是女性HCA的经典原因，但也是HCC的边缘原因，而代谢综合征则是男性HCA恶性转化相关的一种新兴疾病，在这种情况下可能是HCC的易感因素。
Objective Hepatocellular adenomas (HCAs) classically develop in women who are taking oral contraceptives and have a risk of malignant transformation into hepatocellular carcinoma (HCC). HCA with malignant transformation is, however, an ill-defined entity thought to be an anecdotic pathway to HCC. The objective of this study was to characterise malignancy occurring within HCA.Design, setting and patients A series of histology proven HCAs managed between 1993 and 2008 in a tertiary hepato-biliary centre (218 patients, 184 women and 34 men) were screened to identify HCA with malignant transformation.Main outcome measures The incidence of HCA with malignant transformation was analysed through the study period and associated conditions were retrieved. They were sub-typed according to their molecular features and the malignant compartment was mapped.Results Areas of HCC within HCA were observed in 23 patients and the risk of malignant transformation was 4% in women and 47% in men. The number of women whose HCA had malignant changes has remained stable during the study period and oral contraception was the only associated condition. The number of men with such transformation has markedly increased since 2000 and the metabolic syndrome has become the most frequent associated condition. Two-thirds of HCAs with malignant transformation were beta-catenin activated and one-third displayed cell atypias. Both features were more prevalent in men. The median diameter of HCA with malignancy was 10 cm and only three were 5 cm or less.Conclusion Prevalence of malignancy within HCA is 10 times more frequent in men than in women and management of HCA should primarily be based on gender. Whereas oral contraception is a classical cause of HCA in women but a marginal cause of HCC, the metabolic syndrome appears as an emerging condition associated with malignant transformation of HCA in men, and is the likely predisposing condition for HCC in this setting.