Morphologic and Molecular Findings in Myxoid Hepatic Adenomas

Daniel J. Rowan, Saba Yasir, Zongming E. Chen, Taofic Mounajjed, Sibel Erdogan Damgard, Lisa Cummins, Lizhi Zhang, Emma Whitcomb, Vince Falck, Sanford M. Simon, Aatur D. Singhi, Michael S. Torbenson

Research output: Contribution to journalArticlepeer-review


Myxoid hepatic adenomas are a rare subtype of hepatic adenomas with distinctive deposition of extracellular myxoid material between the hepatic plates. A total of 9 cases were identified in 6 women and 3 men with an average of 59±12 years. The myxoid adenomas were single tumors in 5 cases and multiple in 4 cases. In 1 case with multiple adenomas, the myxoid adenoma arose in the background of GNAS-mutated hepatic adenomatosis. Myxoid hepatic adenomas had a high frequency of malignant transformation (N=5 cases). They were characterized at the molecular level by HNF1A inactivating mutations, leading to loss of LFABP protein expression. In addition, myxoid adenomas had recurrent mutations in genes within the protein kinase A (PKA) pathway or in genes that regulate the PKA pathway: GNAS, CDKN1B (encodes p27), and RNF123. In sum, myxoid adenomas are rare, occur in older-aged persons, have a high risk of malignant transformation, and are characterized by the combined inactivation of HNF1A and additional mutations that appear to cluster in the PKA pathway.

Original languageEnglish (US)
Pages (from-to)1098-1107
Number of pages10
JournalAmerican Journal of Surgical Pathology
Issue number8
StatePublished - Aug 2021


  • HNF1A
  • LFABP1
  • fibrolamellar carcinoma
  • hepatic adenoma
  • hepatocellular adenoma
  • myxoid
  • protein kinase A

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine


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