Hepatocellular carcinoma associated with focal nodular hyperplasia
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Hepatocellular carcinoma associated with focal nodular hyperplasia
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Virchows Arch (2001) 438:408–411 DOI 10.1007/s004280000348
Abstract We describe a hepatocellular carcinoma partially surrounded by focal nodular hyperplasia in a 65year-old female patient. In order to clarify the relationship of the hepatocellular carcinoma and the adjacent focal nodular hyperplasia, clonal analysis was conducted. The clonal analysis was based on the methylation pattern of the polymorphic X-chromosome-linked androgen receptor gene (HUMARA). The allelic bands from the amplification of the focal nodular hyperplasia and of the hepatocellular carcinoma showed a significant reduction in the intensity of one of the two alleles as compared with two alleles of equal intensity in the buff coat after HhaI digestion, which indicated that these two parts were monoclonal. However, the inactivated allele in the focal nodular hyperplasia and that in the hepatocellular carcinoma were not identical. Therefore, the focal nodular hyperplasia and hepatocellular carcinoma probably derived from the clonal expansion of two different clones. Keywords Focal nodular hyperplasia · Hepatocellular carcinoma · Androgen receptor gene · HUMARA · Clonality
Introduction Focal nodular hyperplasia (FNH) is a common benign hepatic tumor. It is generally considered to be a hyperplastic response to an abnormal blood supply [13]. However, its nature and pathogenesis are still controversial. It has been recently shown to be a clonal proliferative disease using HUMARA (methylation pattern of the polymorphic X-chromosome-linked androgen receptor gene) analysis [2]. Its associations with fibrolamellar hepatocellular carcinoma (HCC) were also reported [1, 11, 12]. Although some reports indicated an association between FNH and HCC, most authors did not consider a pathogenetic correlation between them. In this report, we describe a FNH arising at the periphery of a HCC. Both lesions arose from clonal expansion of two different clones.
Clinical history
T.-B. Chou Department of Zoology, National Taiwan University, Taipei, Taiwan
A 65-year-old Taiwanese female patient, with a history of pernicious anemia for several years, was noted to have hepatomegaly in a routine follow-up. Laboratory data were as follows: aspartate aminotransferase (AST) 240 U/l (normal
