Atypical hepatocellular
neoplasm (AHN) is an
adenoma-like hepatic
tumor that even occurs in noncirrhotic liver of males (any age) or females ≥ 50 years old, or associates focal atypical features. In this article, 2 unusual cases diagnosed in elderly cirrhotic patients, unrelated to
steroids, are presented. The first case was incidentally diagnosed in an 83-year-old female. During laparoscopic surgery for
cholecystectomy,
hemoperitoneum was installed and
laparotomy was necessary to remove a 70-mm nodular encapsulated hepatic
tumor that was microscopically composed by hepatocyte-like cells with clear cytoplasm, arranged in 1- to 2-cell-thick plates and intermingled with areas of peliosis, negative for
alpha fetoprotein (αFP), p53, and
keratin 7, with low Ki67 index and intact
reticulin framework. The second case was incidentally diagnosed at ultrasound examination in a 66-year-old male. The surgical specimen was a 50-mm solid multinodular
tumor that microscopically consisted of 3-cell-thick plates of hepatocyte-like cells with acinar, pseudoglandular, and trabecular architecture, intermingled with peliotic areas, without nuclear atypia and disintegrated
reticulin framework. Both of the cases occurred in cirrhotic liver. The
tumor cells were marked by AE1/AE3
keratin, displayed a Ki67 index < 5% and were negative for αFP, p53, and
keratin 7. No recurrences or any other disorder occurred 6 months after surgery. In cirrhotic liver,
adenomas with peliosis that do not satisfy all the diagnosis criteria synthesized in the article should be considered AHNs and differential diagnosis includes
hepatocellular carcinoma but also
focal nodular hyperplasia, regenerative nodules, and dysplastic nodules. This histological entity is not yet included in the WHO Classification list.