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Abstract：
UNASSIGNED: Hepatocellular adenoma (HCA) is a rare liver tumor. We report a case of a radio-resistant liver tumor that was removed surgically and found to be HCA.
METHODS: A 37-year-old Japanese man was incidentally diagnosed with a liver tumor. He had no history of viral hepatitis nor metabolic disorders. MRI revealed a tumor enhancing in arterial phase, followed by washout in late phase, and hypointensity in hepatobiliary phase. A diagnosis of hepatocellular carcinoma (HCC) was made and surgery was advised. However, the patient chose proton beam radiotherapy. Although the tumor initially shrunk, it increased in size thereafter. Therefore, anterior sectionectomy was performed. Histology revealed proliferation of hepatocytes without cytologic atypia. On immunohistochemistry, CRP, SAA, GS, L-FABP, and nuclear expression of β-catenin were positive. A final diagnosis of mixed inflammatory and β-catenin activated HCA was made.
UNASSIGNED: HCA is associated with obesity. The present case was a slightly obese man without history of viral hepatitis. In such cases, HCA should be considered. In the present case, proton beam radiotherapy was performed for a diagnosis of HCC. However, the tumor was radio-resistant.
CONCLUSIONS: HCA shows an almost equal male to female ratio in the Asian population. Molecular classification is vital in the management of HCA. HCC and HCA are often difficult to differentiate; tumor biopsy is necessary for patients with atypical imaging findings and in younger patients without underlying liver disease. Since the effectiveness of radiation therapy on HCA has not been reported, surgery should be preferred.
METHODS: A 37-year-old Japanese man was incidentally diagnosed with a liver tumor. He had no history of viral hepatitis nor metabolic disorders. MRI revealed a tumor enhancing in arterial phase, followed by washout in late phase, and hypointensity in hepatobiliary phase. A diagnosis of hepatocellular carcinoma (HCC) was made and surgery was advised. However, the patient chose proton beam radiotherapy. Although the tumor initially shrunk, it increased in size thereafter. Therefore, anterior sectionectomy was performed. Histology revealed proliferation of hepatocytes without cytologic atypia. On immunohistochemistry, CRP, SAA, GS, L-FABP, and nuclear expression of β-catenin were positive. A final diagnosis of mixed inflammatory and β-catenin activated HCA was made.
UNASSIGNED: HCA is associated with obesity. The present case was a slightly obese man without history of viral hepatitis. In such cases, HCA should be considered. In the present case, proton beam radiotherapy was performed for a diagnosis of HCC. However, the tumor was radio-resistant.
CONCLUSIONS: HCA shows an almost equal male to female ratio in the Asian population. Molecular classification is vital in the management of HCA. HCC and HCA are often difficult to differentiate; tumor biopsy is necessary for patients with atypical imaging findings and in younger patients without underlying liver disease. Since the effectiveness of radiation therapy on HCA has not been reported, surgery should be preferred.
摘要：
■肝细胞腺瘤（HCA）是一种罕见的肝脏肿瘤。我们报告了一例手术切除的放射性肝肿瘤，发现是HCA。
方法：一名37岁的日本男子偶然被诊断患有肝肿瘤。患者无病毒性肝炎病史，无代谢紊乱。MRI显示肿瘤在动脉期增强,随后在后期进行冲洗，肝胆期低张力。诊断为肝细胞癌（HCC），并建议进行手术。然而,患者选择了质子束放疗。虽然肿瘤最初缩小了，此后，它的大小增加了。因此,进行了前路切除术。组织学显示肝细胞增殖，无细胞学异型。关于免疫组织化学，CRP,SAA,GS,L-FABP,β-catenin细胞核表达呈阳性。最终诊断为混合炎症和β-连环蛋白激活的HCA。
■HCA与肥胖有关。本病例是一名轻度肥胖的男子，没有病毒性肝炎病史。在这种情况下,HCA应该考虑。在目前的情况下,进行质子束放射治疗以诊断HCC。然而,肿瘤是耐放射性的.
结论：HCA显示亚洲人群中男女比例几乎相等。分子分类在HCA的管理中至关重要。HCC和HCA通常难以区分；对于影像学表现不典型的患者和没有潜在肝病的年轻患者，肿瘤活检是必要的。由于尚未报道放射治疗对HCA的有效性，手术应该是首选。
方法：一名37岁的日本男子偶然被诊断患有肝肿瘤。患者无病毒性肝炎病史，无代谢紊乱。MRI显示肿瘤在动脉期增强,随后在后期进行冲洗，肝胆期低张力。诊断为肝细胞癌（HCC），并建议进行手术。然而,患者选择了质子束放疗。虽然肿瘤最初缩小了，此后，它的大小增加了。因此,进行了前路切除术。组织学显示肝细胞增殖，无细胞学异型。关于免疫组织化学，CRP,SAA,GS,L-FABP,β-catenin细胞核表达呈阳性。最终诊断为混合炎症和β-连环蛋白激活的HCA。
■HCA与肥胖有关。本病例是一名轻度肥胖的男子，没有病毒性肝炎病史。在这种情况下,HCA应该考虑。在目前的情况下,进行质子束放射治疗以诊断HCC。然而,肿瘤是耐放射性的.
结论：HCA显示亚洲人群中男女比例几乎相等。分子分类在HCA的管理中至关重要。HCC和HCA通常难以区分；对于影像学表现不典型的患者和没有潜在肝病的年轻患者，肿瘤活检是必要的。由于尚未报道放射治疗对HCA的有效性，手术应该是首选。
