Systematic review of hepatocellular adenoma in China and other regions

Abstract

Hepatocellular adenoma (HCA) is a benign liver neoplasm with a risk of spontaneous bleeding and malignant transformation. The aim of this review article is to review all the case reports and case series of patients with HCA from 1998 to 2008 in China and other parts of the world in order to compare clinical presentation, surgical management and outcomes. A search for all reports of HCA in the world literature from 1998 to 2008 was performed. A total of 356 patients were identified, including 191 patients from China, 104 from Europe, 46 from North America, and 15 from South-East Asia. A female predominance was not observed in Chinese patients in contrast to the other regions. Acute/chronic abdominal pain was the main clinical presentation in all regions. Twenty patients were diagnosed with coexistent hepatocellular carcinoma (HCC), and hepatitis B virus infection (HBV) was found among six of them. The management of HCA consisted of resection in most cases. The clinical presentation of HCA in China differed from other parts of the world regarding male predominance and a higher incidence of coexistent HCC in China. This might be the result of the birth control policy in China, limited oral contraceptive use, and the higher incidence of HBV.

Hepatocellular Adenoma

“…There is no conclusive evidence to prove a correlation of the size of HA and rupture; some authors report an increased risk of rupture in tumors more than 6.5 cm in size [ 17 ]. A report, analyzing the evolution of HAs and their risk of rupture, found that the mean diameter of the lesions in China, Europe, and North America were 10.8, 12.4, and 14 cm, respectively [ 5 ]. There are two types of hemorrhage which are mostly observed in HA: hemorrhage inside the HA nodule, usually admixed with necrotic changes, and spontaneous hemorrhagic rupture which can cause subcapsular hematoma and possible hemoperitoneum.…”

“…The issue of when HA develops into malignancy and which factors infl uence malignant degeneration are still being investigated. In some reports [ 5 ] a total of 5.6 % showed HCC foci within an adenoma upon fi nal pathology; the mean size of the tumor with HCC was larger than the mean tumor diameter in benign HA (11.2 cm vs 7.8 cm). The risk of malignancy is particularly higher for β-catenin mutation HA, which are most frequently associated with glycogenosis type I, androgenic hormone intake, and familial adenomatous polyposis.…”

“…Tumor size is variable with a range of 1-30 cm (usually 8-15 cm). In reports from Southeast Asia and North America, the rate of solitary lesions is 80 and 65.2 %, respectively; in European reports, more than half of patients with HA have multiple lesions: the reason for this difference is unclear [ 5 ].…”

“…In contrast, Chinese literature shows that only 37.7 % of patients with HA is female and only 11 % of them has a history of oral contraceptives/anabolic steroid use, probably because the criterion for the surgical treatment of HA may be more rigorous in China, considering the large prevalence of liver cancer: surgeons should rather advise tumor resection even if the presumptive diagnosis is adenoma, especially in male patients [ 5 ].…”

Swainsonine inhibits growth and potentiates the cytotoxic effect of paclitaxel in hepatocellular carcinoma in vitro and in vivo

“…Hepatocellular carcinoma (HCC) is one of the most frequent causes of death from solid tumors in the world, particularly in China (1,2). Currently, surgical intervention, including hepatic resection and liver transplantation, is the only therapy considered to provide a cure.…”