Incidental inflammatory adenoma with β-catenin activation in the setting of paediatric NASH.

Hepatocellular adenomas (HCA) are benign tumours with potential for malignant transformation with no recommendations regarding management in the paediatric population. We report a case of an inflammatory adenoma with β-catenin activated pathway in an obese, paediatric patient with nonalcoholic steatohepatitis (NASH).

CASE REPORT: An 11-year-old female presented with a microlobulated liver lesion measuring >5 cm in magnetic resonance imaging (MRI) with inflammatory adenoma with β-catenin activated pathology arising in a background of NASH, nonalcoholic fatty liver disease (NAFLD) activity score 5/8. Imaging follow-up demonstrated stable disease without progression for 3 years.

DISCUSSION: Malignant transformation of Hepatocellular adenomas in a child is approximately 4.2%. It is unknown if hepatic steatosis increases this risk. Obese patients mainly develop inflammatory and β-catenin activated (highest risk for malignant transformation) adenomas. Our patient had inflammatory and β-catenin activation, which led to monitoring for malignant transformation.

CONCLUSION: We report a β-catenin activated inflammatory adenoma in a child with obesity and NASH with ongoing expectant management.