Liver Adenomatosis: Reappraisal, Diagnosis, and Surgical Management

Chiche, Laurence; Dao, Thông; Salamé, Ephrem; Galais, Marie Pierre; Bouvard, N.; Schmutz, G; Rousselot, Pierre; Bioulac‐Sage, Paulette; Ségol, P; Gignoux, M

doi:10.1097/00000658-200001000-00011

Cited by 168 publications

(170 citation statements)

References 14 publications

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“…It shows a slow progression but sometimes causes rupture, hemorrhage, and malignant transformation [1][2][3][4][5][6][7][8][9][10][11][12][13]. Moreover, differential diagnosis of HCA from focal nodular hyperplasia and well-differentiated HCC is sometimes difficult [5][6][7][8][9][10][11][12][13][14].…”

Section: Discussionmentioning

confidence: 99%

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Two cases of hepatocellular adenomatosis treated with transcatheter arterial embolization

et al. 2009

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Hepatocellular adenoma is a rare benign tumor of the liver. However, some complications, such as hemorrhage, rupture, and malignant transformation, have been reported previously. Surgical resection is considered to be the best choice of treatment, when adenomas are increasing in size, while resection is difficult to perform when multiple adenomas develop throughout the liver. Here, we report two cases of multiple hepatocellular adenomatosis. One patient had a history of aplastic anemia and the other had glycogen storage disease. We treated them with transcatheter arterial embolization (TAE) to prevent hemorrhage and rupture. After TAE, most parts of the adenomas showed necrotic change. These cases suggest that TAE is an effective treatment of hepatocellular adenomatosis.

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Section: Discussionmentioning

confidence: 99%

“…The latter is termed hepatic adenomatosis [5,8,9]. Although most cases of adenomas are asymptomatic and detected incidentally, HCA may undergo rupture and lead to life-threatening hemorrhage [10,11].…”

Section: Introductionmentioning

confidence: 99%

Two cases of hepatocellular adenomatosis treated with transcatheter arterial embolization

et al. 2009

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“…2 In 1978, Foster and collaborators described another clinical entity, which was the first case of familial adenomatosis associated with diabetes, 3 later confirmed by others. [4][5][6][7] Some small HA may regress after withdrawal of oral contraceptives; however, they usually remain stable, or increase in size. They may bleed, or rarely, undergo malignant transformation.…”

Section: See Editorial On Page 401mentioning

confidence: 99%

Genotype–phenotype correlation in hepatocellular adenoma: New classification and relationship with HCC

et al. 2006

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Hepatocellular adenomas are benign tumors that can be difficult to diagnose. To refine their classification, we performed a comprehensive analysis of their genetic, pathological, and clinical features. A multicentric series of 96 liver tumors with a firm or possible diagnosis of hepatocellular adenoma was reviewed by liver pathologists. In all cases, the genes coding for hepatocyte nuclear factor 1␣ (HNF1␣) and ␤-catenin were sequenced. No tumors were mutated in both HNF1␣ and ␤-catenin enabling tumors to be classified into 3 groups, according to genotype. Tumors with HNF1␣ mutations formed the most important group of adenomas (44 cases). They were phenotypically characterized by marked steatosis (P < 10 ؊4 ), lack of cytological abnormalities (P < 10 ؊6 ), and no inflammatory infiltrates (P < 10 ؊4 ). In contrast, the group of tumors defined by ␤-catenin activation included 13 lesions with frequent cytological abnormalities and pseudo-glandular formation (P < 10 ؊5 ). The third group of tumors without mutation was divided into two subgroups based on the presence of inflammatory infiltrates. The subgroup of tumors consisting of 17 inflammatory lesions, resembled telangiectatic focal nodular hyperplasias, with frequent cytological abnormalities (P ‫؍‬ 10 ؊3 ), ductular reaction (P < 10 ؊2 ), and dystrophic vessels (P ‫؍‬ .02). In this classification, hepatocellular carcinoma associated with adenoma or borderline lesions between carcinoma and adenoma is found in 46% of the ␤-catenin-mutated tumors whereas they are never observed in inflammatory lesions and are rarely found in HNF1␣ mutated tumors (P ‫؍‬ .004). In conclusion, the molecular and pathological classification of hepatocellular adenomas permits the identification of strong genotype-phenotype correlations and suggests that adenomas with ␤-catenin activation have a higher risk of malignant transformation. (

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“…(2) LA is a heterogeneous disease, and imaging often underestimates the number of lesions present. Chiche et al (3) described 2 forms of LA: a massive form with an enlarged liver and typically large and necrotic tumors, and a multifocal form with a normalsized liver in which 1 or 2 adenomas may predominate over the smallest lesions.…”

Section: Liver Transplantation 22 516-526 2016 Aasldmentioning

confidence: 99%

“…We identified 2 forms of adenomatosis as defined by Chiche et al, (3) ie, massive or multifocal forms.…”

Section: Diseasementioning

confidence: 99%

Liver transplantation for adenomatosis: European experience

et al. 2016

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The aim of this study was to collect data from patients who underwent liver transplantation (LT) for adenomatosis; to analyze the symptoms, the characteristics of the disease, and the recipient outcomes; and to better define the role of LT in this rare indication. This retrospective multicenter study, based on data from the European Liver Transplant Registry, encompassed patients who underwent LT for adenomatosis between January 1, 1986, and July 15, 2013, in Europe. Patients with glycogen storage disease (GSD) type IA were not excluded. This study included 49 patients. Sixteen patients had GSD, and 7 had liver vascular abnormalities. The main indications for transplantation were either a suspicion of hepatocellular carcinoma (HCC; 15 patients) or a histologically proven HCC (16 patients), but only 17 had actual malignant transformation (MT) of adenomas. GSD status was similar for the 2 groups, except for age and the presence of HCC on explants (P = 0.030). Three patients with HCC on explant developed recurrence after transplantation. We obtained and studied the pathomolecular characteristics for 23 patients. In conclusion, LT should remain an extremely rare treatment for adenomatosis. Indications for transplantation primarily concern the MT of adenomas. The decision should rely on morphological data and histological evidence of MT. Additional indications should be discussed on a case‐by‐case basis. In this report, we propose a simplified approach to this decision‐making process.

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Liver Adenomatosis: Reappraisal, Diagnosis, and Surgical Management

Abstract: Liver adenomatosis is a rare disease, more common in women, where outcome and evolution vary and are exacerbated by estrogen intake. Most often, conservative surgery is indicated. Liver transplantation is indicated only in highly symptomatic and aggressive forms of the disease.

Cited by 168 publications

References 14 publications

Two cases of hepatocellular adenomatosis treated with transcatheter arterial embolization

Two cases of hepatocellular adenomatosis treated with transcatheter arterial embolization

Genotype–phenotype correlation in hepatocellular adenoma: New classification and relationship with HCC

Liver transplantation for adenomatosis: European experience

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