Multifocal Hepatic Neoplasia in 3 Children With APC Gene MutationGupta, Anita MD*; Sheridan, Rachel M. MD*; Towbin, Alexander MD†; Geller, James I. MD‡; Tiao, Gregory MD§; Bove, Kevin E. MD*The American Journal of Surgical Pathology: July 2013 - Volume 37 - Issue 7 - p 1058–1066 doi: 10.1097/PAS.0b013e31828aeb18 Original Articles Abstract Author Information Hepatoblastoma (HB), the most common hepatic neoplasm in children is associated with germline mutations in adenomatous polyposis coli tumor-suppressor gene that cause familial adenomatous polyposis syndrome. Individuals with familial adenomatous polyposis have a 750 to 7500× the risk of developing HB. We report 3 children with APC gene mutation, who underwent resection or liver transplant for HB. In addition to HB, all 3 patients had multiple independent adenoma-like nodules lacking qualities of intrahepatic metastases. Twenty-five nodules were subjected to immunohistochemical analysis using a panel of antibodies including glypican-3 (GPC3), β-catenin, cytokeratin AE1/AE3, CD34, Ki-67, glutamine synthetase (GS), and fatty acid binding protein. The nodules were round, ranged in size from 0.2 to 1.5 cm, and paler than the background liver. All lacked the chemotherapy effect. The nodules were circumscribed but nonencapsulated and composed of well-differentiated hepatocytes with occasional minor atypical features and absent or rare portal tracts. One lesion displayed a “nodule-within-nodule” pattern. The nodules demonstrated diffuse GS overexpression. Nine (36%) nodules were focally reactive for GPC3, and 1 (4%) displayed focal nuclear β-catenin expression. The associated HB showed diffuse expression of GS, GPC3, and β-catenin nuclear staining. We interpret these nodules as neoplastic with most being adenomas (GPC3 negative) that show features of independent origin and represent early stages of carcinogenesis, implying potential to progress to HB or hepatocellular carcinoma. To our knowledge, this is the first report of multifocal neoplasms in patients with HB and APC gene mutation. Departments of *Pathology †Radiology ‡Oncology §Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: Kevin E. Bove, MD, Department of Pathology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 1010, Cincinnati, OH 45229-3039 (e-mail: email@example.com). © 2013 by Lippincott Williams & Wilkins.