A systematic review on the complications and management of hepatic adenomas: a call for a new approach

Abstract

Hepatic adenomas are benign hepatic lesions with heterogeneous characteristics. Awareness of complications, including haemorrhage and malignant transformation, has improved alongside a concurrent rise in their detection. Monitoring and management guidelines, however, remain inconsistent. This systematic review analyses the natural history of hepatic adenomas, and existing and novel risk factors associated with haemorrhage and malignant transformation. Results of this systematic review commonly identified male sex, and the beta-catenin histopathological hepatic adenoma subtype, as risk factors for malignant transformation, whilst those associated with haemorrhage included lesion size and number, exophytic nature, and recent hormone use. Overall, females demonstrated higher rates of haemorrhage, whilst males exhibited a higher risk of hepatocellular carcinoma development. This systematic review highlights that tumour size and subtype may not be as characteristically linked with complications as previously thought. We have additionally reported novel risk factors contributing to development of hepatic adenoma-related complications. We conclude by highlighting the risk of taking a conservative approach to seemingly low-risk lesions and suggest revised practice guidelines.

Turner syndrome may be associated with hepatic adenoma

“…The observed rate of hepatic adenoma, however, is more than expected by oral contraceptive use alone in this population (Patacsil et al, 2020;Rodrigues et al, 2020). Recent examinations propose that an endogenous imbalance of sex hormones may be a risk factor (Beuers et al, 1991;Cazorla et al, 2014;Shreenath & Kahloon, 2023).…”

“…Complications of hepatic adenoma include malignant transformation in about 4% of cases and hemorrhagic rupture in up to 20%-30% of cases (Szor et al, 2013). Hepatic adenomas are associated with exposure to exogenous estrogen (Patacsil et al, 2020;Rodrigues et al, 2020), and women with F I G U R E 2 CT scan demonstrating a hepatic adenoma measuring 54.6 mm  95.3 mm.…”

“…Hepatic adenomas are well‐recognized lesions that are uncommon and may be associated with high morbidity and mortality. Current recommendations for the management of hepatic adenoma include elective resection for lesions >5 cm in diameter, though recent literature advocates for intervention in smaller adenomas due to the risk of complications (Bioulac‐Sage et al, 2017; Rodrigues et al, 2020). Complications of hepatic adenoma include malignant transformation in about 4% of cases and hemorrhagic rupture in up to 20%–30% of cases (Szor et al, 2013).…”

“…Hepatic adenomas are rare, epithelial tumors of the liver. Annual incidence of hepatic adenomas worldwide is approximately one per 1,000,000, though oral contraceptive users have a four‐fold increase in incidence (Patacsil et al, 2020; Rodrigues et al, 2020). The prevalence of hepatic adenoma is difficult to assess due to the tendency to be asymptomatic in most cases and ability of lesions to self‐resolve.…”

“…One study estimates the prevalence to be approximately 0.04% in the general population (Kaltenbach et al, 2016; Patacsil et al, 2020). Hepatic adenomas are typically described as benign tumors although they can be associated with major complications including hemorrhage and malignant transformation (Bioulac‐Sage et al, 2017; Rodrigues et al, 2020). Lesions warrant close clinical monitoring once discovered.…”