Hepatocellular adenoma

Hepatocellular adenoma
Micrograph of a hepatic adenoma (bottom of image). H&E stain
Classification and external resources
ICD-O M8170/0
DiseasesDB 5726
eMedicine med/48
MeSH D018248

Hepatocellular adenoma, also hepatic adenoma, or rarely hepadenoma, is an uncommon benign liver tumor which is associated with increased levels of estrogen.[1] Patients of advanced age, or taking higher potency hormones, or patients with prolonged duration of use have a significantly increased risk of developing hepatocellular adenomas.[2]

Signs and symptoms

About 25–50% of hepatic adenomas cause pain in the right upper quadrant or epigastric region of the abdomen.[2] Since hepatic adenomas can be large (8–15 cm), patients may notice a palpable mass. However, hepatic adenomas are usually asymptomatic, and may be discovered incidentally on imaging ordered for some unrelated reason.[2] If not treated, there is a 30% risk of bleeding.[3] Bleeding may lead to hypotension, tachycardia, and sweating (diaphoresis).

Diagnosis

It is important to distinguish hepatic adenoma from other benign liver tumors, such as hemangiomas and focal nodular hyperplasia, because hepatic adenomas have a small but meaningful risk of progressing into a malignancy.[3] MRI is the most useful investigation in the diagnosis and work-up.[4] A poly-phasic CT scan is another useful test for diagnosing hepatic adenoma.[3]

Large hepatic adenomas have a tendency to rupture and bleed massively inside the abdomen.

Radiologic differential diagnosis

Pathologic diagnosis

Micrograph of a hepatic adenoma demonstrating a regular reticulin scaffold. Reticulin stain

Hepatic adenomas are, typically, well-circumscribed nodules that consist of sheets of hepatocytes with a bubbly vacuolated cytoplasm. The hepatocytes are on a regular reticulin scaffold and less or equal to three cell thick.

The histologic diagnosis of hepatic adenomas can be aided by reticulin staining. In hepatic adenomas, the reticulin scaffold is preserved and hepatocytes do not form layers of four or more hepatocytes, as is seen in hepatocellular carcinoma.

Cells resemble normal hepatocytes and are traversed by blood vessels but lack portal tracts or central veins.

Etiology

Ninety percent of hepatic adenomas arise in women aged 20–40, most of whom use oral contraceptives.

Hepatic adenomas are related to glycogen storage diseases, type 1, as well as anabolic steroid use.

Treatment

Some authors feel that all hepatocellular adenoma should be resected, because of the risk of rupture causing bleeding and because they may contain malignant cells.[5] Current recommendations are that all hepatic adenomas should be resected, as long as they are surgically accessible and the patient is a reasonable operative candidate.[6] Patients with adenomas should avoid oral contraceptives or hormonal replacement therapy.

Pregnancy could cause the adenoma to grow faster, so patients with hepatic adenomas should avoid pregnancy.[7]

Additional images

References

  1. ↑ Rooks J, Ory H, Ishak K, Strauss L, Greenspan J, Hill A, Tyler C (1979). "Epidemiology of hepatocellular adenoma. The role of oral contraceptive use.". JAMA. 242 (7): 644–8. doi:10.1001/jama.242.7.644. PMID 221698.
  2. 1 2 3 "Hepatocellular Adenoma: eMedicine Gastroenterology".
  3. 1 2 3 Anthony S. Fauci; Eugene Braunwald; Dennis L. Kasper; Stephen L. Hauser; Dan L. Longo; J. Larry Jameson; Joseph Loscalzo (2008). Harrison's principles of internal medicine (17th ed.). New York: McGraw-Hill Medical. pp. Chapter 92 (benign liver tumors). ISBN 978-0071466332.
  4. ↑ Hussain S, van den Bos I, Dwarkasing R, Kuiper J, den Hollander J (2006). "Hepatocellular adenoma: findings at state-of-the-art magnetic resonance imaging, ultrasound, computed tomography and pathologic analysis.". Eur Radiol. 16 (9): 1873–86. doi:10.1007/s00330-006-0292-4. PMID 16708218.
  5. ↑ Toso C, Majno P, Andres A, Rubbia-Brandt L, Berney T, Buhler L, Morel P, Mentha G (2005). "Management of hepatocellular adenoma: solitary-uncomplicated, multiple and ruptured tumors.". World J Gastroenterol. 11 (36): 5691–5. PMID 16237767.Full text
  6. ↑ Cho, S; Marsh J; Steel J; et al. (2008). "Surgical management of hepatocellular adenoma: take it or leave it?". Ann Surg Oncol (15): 2795–2803.
  7. ↑ "Hepatocellular Adenoma Treatment & Management". WebMD. Medscape. Retrieved 11 July 2012.
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