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

Summary 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.