Current Approaches in the Management of Hepatic Adenomas

Tsilimigras, Diamantis I.; Rahnemai‐Azar, Amir A.; Ntanasis‐Stathopoulos, Ioannis; Gavriatopoulou, Maria; Moris, Demetrios; Spartalis, Eleftherios; Cloyd, Jordan M.; Weber, Sharon M.; Pawlik, Timothy M.

doi:10.1007/s11605-018-3917-4

Cited by 23 publications

(31 citation statements)

References 85 publications

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“…Based on currently available clinical and molecular risk factors, a personalized treatment algorithm and indications for surgical management of HCA were proposed in a few previous reports [17–19]. According to those reports, surgical resection is generally recommended for patients at a substantial risk of complications, such as those with tumor size larger than 5 cm, a tumor increasing in size, presence of the β-catenin-activated subtype, imaging features suggestive of malignancy, concurrent dysplasia and/or the inability to rule out HCC, progressively rising α-fetoprotein levels, and male sex [17, 18]. Therefore, our patient was scheduled to undergo surgical resection due to the largest HCA, larger than 5 cm, and the associated potential risks of rupture and malignant transformation.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…Management strategies for HAs depend on the underlying risk factors and size. In patients on hormone replacement therapies (including estrogen and androgen) complete cessation is recommended as studies have shown a regression rate of almost 80% and even complete resolution of the tumor in some patients on stopping OCPs (13). In obese patients, weight loss and even bariatric surgery has proved to be beneficial.…”

Section: Discussionmentioning

confidence: 99%

“…HAs < 5 cm in size are managed conservatively as they tend to have a benign and uncomplicated clinical course and hence are followed up every 6 months by CT/MRI for the first two years and then annually. In hemodynamically stable patients with bleeding HAs, transarterial embolization (TAE) is considered as the first treatment option, with studies showing a 75% tumor regression rate (13). Limited available data has shown that ablative techniques (e.g.…”

Section: Discussionmentioning

confidence: 99%

Malignant transformation of hepatic adenoma complicated by rupture and hemorrhage: An extremely rare clinical entity

Mathew

Manolea

Girgis

et al. 2019

IRDR

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“…HCAs are rare monoclonal benign tumors of the liver with an estimated incidence of 3-4/100000 per year in Europe and North America[2,4]. Most HCAs are solitary and usually incidental findings in patients undergoing radiological work up for unrelated or non-specific symptoms[6]. They closely relate to the dose and duration of OCP use, as well as they tend to regress with the withdrawal of hormonal therapy, so its response to hormonal stimulation is questionless according to several studies[1,7,8].…”

Section: Discussionmentioning

confidence: 99%

“…In practice, both MRI and biopsy with IHQ are usefull in decision making to help classify HCAs in high or low risk of complications. However, performing a biopsy systematically is still controversial[6]. In the Ronot et al[14] study comparing the efficacy of MRI findings in the diagnosis of these lesions against a routine histological analysis, a 74.5% of agreement between both techniques was observed, with a likelihood ratio of subtype characterization by MRI higher than 20.…”

Section: Discussionmentioning

confidence: 99%

Malignant transformation of hepatocellular adenoma in a young female patient after ovulation induction fertility treatment: A case report

Glinka

Clariá

Fratanoni

et al. 2019

WJGS

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BACKGROUND Hepatocellular adenoma (HCA) is a rare benign liver tumor usually affecting young women with a history of prolonged use of hormonal contraception. Although the majority is asymptomatic, a low proportion may have significant complications such as bleeding or malignancy. Despite responding to the hormonal stimulus, the desire for pregnancy in patients with small HCA is not contraindicated. However, through this work we demonstrate that intensive hormonal therapies such as those used in the treatment of infertility can trigger serious complications CASE SUMMARY A 33-year-old female with a 10-year history of oral contraceptive use was diagnosed with a hepatic tumor as an incidental finding in an abdominal ultrasound. The patient showed no symptoms and physical examination was unremarkable. Laboratory functional tests were within normal limits and tests for serum tumor markers were negative. An abdominal magnetic resonance imaging (MRI) was performed, showing a 30 mm × 29 mm focal lesion in segment VI of the liver compatible with HCA or Focal Nodular Hyperplasia with atypical behavior. After a total of six years of follow-up, the patient underwent ovulation induction treatment for infertility. On a following MRI, a suspected malignancy was warned and hence, surgery was decided. The surgical specimen revealed malignant transformation of HCA towards trabecular hepatocarcinoma with dedifferentiated areas. There was non-evidence of tumor recurrence after three years of clinical and imaging follow-up. CONCLUSION HCAs can be malignant regardless its size and low-risk appearance on MRI when an ovultation induction therapy is indicated.

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Current Approaches in the Management of Hepatic Adenomas

Abstract: Future genomic-based multicenter studies are required to provide a strong basis for formulating an evidence-based risk-adapted model that guides individualized management strategies for patients with HA.

Cited by 23 publications

References 85 publications

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

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

Malignant transformation of hepatic adenoma complicated by rupture and hemorrhage: An extremely rare clinical entity

Malignant transformation of hepatocellular adenoma in a young female patient after ovulation induction fertility treatment: A case report

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