Case of resected multiple hepatocellular adenomas in a young man with severe obesity

Abstract

Background Hepatocellular adenoma (HCA) is a rare liver tumor that has the potential for rupture and malignant transformation. Here, we report a case of multiple hepatocellular adenomas (HCAs) that were treated by surgical resection. Case presentation An 18-year-old man was admitted to our hospital with proteinuria. His height was 176.5 cm, weight was 126 kg, and body mass index was 40 kg/m 2 . A liver tumor was incidentally found on abdominal ultrasonography. Contrast-enhanced computed tomography and gadoxetic acid-enhanced magnetic resonance imaging revealed three hepatic tumors that were 68 mm, 16 mm, and 9 mm in segments 3/4, 8, and 1, respectively. A percutaneous needle biopsy of the largest tumor was performed, the diagnosis of unclassified type HCA was made, and laparoscopic partial liver resection was performed of all three. The postoperative course was uneventful, and the patient was discharged 12 days later. An immunohistochemical examination revealed positivity for serum amyloid A protein, no decrease in fatty acid-binding protein, and negativity for β-catenin, glutamine synthetase, and cytokeratin 7. Therefore, these tumors were diagnosed as inflammatory type HCAs. Conclusions We reported an extremely rare case of multiple resected HCAs in a young, obese Japanese man. Our findings suggest that HCA should be considered in the differential diagnosis of liver tumor in obese patients. Further studies that consider clinical and molecular risk factors are required to establish individualized treatment plans for HCA in obese patients.

Is This Patient’s Liver Mass Cancer?

“…Obesity and metabolic syndrome are seen in patients with HCA and are thought to be associated with malignant progression ( Marrero et al, 2014 ). Obesity is considered by some to be the new risk factor for the development of HCA ( Oji et al, 2019 ). According to Bioulac-Sage and colleagues (2013), females represent the majority of overweight/obese patients with HCAs.…”

From an Incidental Finding to an Emergent Treatment: A Case Report of a Hepatic Adenomatosis and Large Ruptured Hepatic Adenoma

“…Exposure to hormones, including oral contraceptive pills (OCPs), and obesity have been strongly associated with HA occurrence. The risk of HA in women increases with the prolonged use of OCPs [ 3 – 5 ].…”