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Hepatocellular adenoma was first discovered by Hugh A. Edmondson in 1958 following 50,000 autopsies.<ref name="pmid18333188">{{cite journal| author=Barthelmes L, Tait IS| title=Liver cell adenoma and liver cell adenomatosis. | journal=HPB (Oxford) | year= 2005 | volume= 7 | issue= 3 | pages= 186-96 | pmid=18333188 | doi=10.1080/13651820510028954 | pmc=PMC2023950 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18333188  }} </ref>
Hepatocellular adenoma was first discovered by Hugh A. Edmondson in 1958 following 50,000 autopsies.<ref name="pmid18333188">{{cite journal| author=Barthelmes L, Tait IS| title=Liver cell adenoma and liver cell adenomatosis. | journal=HPB (Oxford) | year= 2005 | volume= 7 | issue= 3 | pages= 186-96 | pmid=18333188 | doi=10.1080/13651820510028954 | pmc=PMC2023950 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18333188  }} </ref>
==Classification==
==Classification==
Hepatocellular adenoma may be classified into four subtypes based on rate of occurence, inflammatory hepatic adenoma, ''HNF 1 alpha'' mutated hepatic adenoma, 'Beta catenin''-mutated hepatic adenoma and unclassified hepatocellular adenoma<ref name=a>Radiopaedia 2015 Hepatic adenoma>{{cite web | title = Radiopedia 2015 Hepatic adenoma [Dr Matt A. Morgan and Dr Koshy Jacob]| url = http://radiopaedia.org/articles/hepatic-adenoma }}</ref>
Hepatocellular adenoma may be classified into four subtypes based on rate of occurence, inflammatory hepatic adenoma, ''HNF 1 alpha'' mutated hepatic adenoma, ''Beta catenin''-mutated hepatic adenoma and unclassified hepatocellular adenoma<ref name=a>Radiopaedia 2015 Hepatic adenoma>{{cite web | title = Radiopedia 2015 Hepatic adenoma [Dr Matt A. Morgan and Dr Koshy Jacob]| url = http://radiopaedia.org/articles/hepatic-adenoma }}</ref>
==Pathophysiology==
==Pathophysiology==
On gross pathology, well circumscribed, nonlobulated,<ref name="pmid11452062">{{cite journal| author=Grazioli L, Federle MP, Brancatelli G, Ichikawa T, Olivetti L, Blachar A| title=Hepatic adenomas: imaging and pathologic findings. | journal=Radiographics | year= 2001 | volume= 21 | issue= 4 | pages= 877-92; discussion 892-4 | pmid=11452062 | doi=10.1148/radiographics.21.4.g01jl04877 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11452062  }} </ref> smooth and soft, white to yellow to brown lesions, are characteristic findings of a solitary hepatocellular adenoma.<ref name="pmid18333188">{{cite journal| author=Barthelmes L, Tait IS| title=Liver cell adenoma and liver cell adenomatosis. | journal=HPB (Oxford) | year= 2005 | volume= 7 | issue= 3 | pages= 186-96 | pmid=18333188 | doi=10.1080/13651820510028954 | pmc=PMC2023950 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18333188  }} </ref>
On gross pathology, well circumscribed, nonlobulated,<ref name="pmid11452062">{{cite journal| author=Grazioli L, Federle MP, Brancatelli G, Ichikawa T, Olivetti L, Blachar A| title=Hepatic adenomas: imaging and pathologic findings. | journal=Radiographics | year= 2001 | volume= 21 | issue= 4 | pages= 877-92; discussion 892-4 | pmid=11452062 | doi=10.1148/radiographics.21.4.g01jl04877 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11452062  }} </ref> smooth and soft, white to yellow to brown lesions, are characteristic findings of a solitary hepatocellular adenoma.<ref name="pmid18333188">{{cite journal| author=Barthelmes L, Tait IS| title=Liver cell adenoma and liver cell adenomatosis. | journal=HPB (Oxford) | year= 2005 | volume= 7 | issue= 3 | pages= 186-96 | pmid=18333188 | doi=10.1080/13651820510028954 | pmc=PMC2023950 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18333188  }} </ref>

Revision as of 15:33, 29 October 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., PhD. Nawal Muazam M.D.[2]

Overview

Hepatocellular adenoma is an uncommon benign liver tumour which is associated with the use of hormonal contraception with a high estrogen content.[1]

Historical Perspective

Hepatocellular adenoma was first discovered by Hugh A. Edmondson in 1958 following 50,000 autopsies.[2]

Classification

Hepatocellular adenoma may be classified into four subtypes based on rate of occurence, inflammatory hepatic adenoma, HNF 1 alpha mutated hepatic adenoma, Beta catenin-mutated hepatic adenoma and unclassified hepatocellular adenoma[3]

Pathophysiology

On gross pathology, well circumscribed, nonlobulated,[4] smooth and soft, white to yellow to brown lesions, are characteristic findings of a solitary hepatocellular adenoma.[2]

Causes

The most common cause of hepatocellular adenoma is oral contraceptive use.[2]

Epidemiology and Demographics

The incidence of hepatic adenoma is approximately 3 per 100,000 individuals worldwide.[2]

Risk factors

The most potent risk factor in the development of hepatocellular adenoma is use of oral contraceptive pills.[5]

Screening

According to the United States Preventive Services Task Force, there is insufficient evidence to recommend routine screening for hepatocellular adenoma.[6]

Differentiating Hepatocellular adenoma from other Diseases

Hepatocellular adenoma must be differentiated from other diseases such as hepatocellular carcinoma (HCC), focal nodular hyperplasia (FNH), liver metastases (hypervascular), haemangioma of the liver, fibrolamellar hepatocellular carcinoma.[3]

Natural History, Complications and Prognosis

If left untreated, 30% of patients with hepatocellular adenoma may progress to develop risk of bleeding.[6]Common complication of Hepatocellular adenoma includes spontaneous rupture, haemorrhage[3][7]and malignant transformation to Hepatocellular carcinoma.[7]

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Chest X Ray

There are no chest x-ray findings associated with hepatocellular adenoma.

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Hepatocellular adenoma can present as right upper quadrant pain, acute abdomen or life threatening bleeding.[2]An elevated concentration of serum alkaline phosphatase and gamma glutamyl transferase may be present in patients with Hepatocellular adenoma.[8]

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

All hepatocellular adenoma should be surgically resected, because of the risk of rupture causing bleeding and because they may contain malignant foci.[9]

References

  1. Rooks J, Ory H, Ishak K, Strauss L, Greenspan J, Hill A, Tyler C (1979). "Epidemiology of hepatocellular adenoma. The role of oral contraceptive use". JAMA. 242 (7): 644–8. PMID 221698.
  2. 2.0 2.1 2.2 2.3 2.4 Barthelmes L, Tait IS (2005). "Liver cell adenoma and liver cell adenomatosis". HPB (Oxford). 7 (3): 186–96. doi:10.1080/13651820510028954. PMC 2023950. PMID 18333188.
  3. 3.0 3.1 3.2 Radiopaedia 2015 Hepatic adenoma>"Radiopedia 2015 Hepatic adenoma [Dr Matt A. Morgan and Dr Koshy Jacob]".
  4. Grazioli L, Federle MP, Brancatelli G, Ichikawa T, Olivetti L, Blachar A (2001). "Hepatic adenomas: imaging and pathologic findings". Radiographics. 21 (4): 877–92, discussion 892-4. doi:10.1148/radiographics.21.4.g01jl04877. PMID 11452062.
  5. How do oral contraceptives affect liver cancer risk. National Cancer Institute 2015. http://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/oral-contraceptives-fact-sheet
  6. 6.0 6.1 Hepatocellular adenoma. USPSTF. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=hepatocellular+adenoma
  7. 7.0 7.1 Aamann L, Schultz N, Fallentin E, Hamilton-Dutoit S, Vogel I, Grønbæk H (2015). "[Hepatocellular adenoma - new classification and recommendations]". Ugeskr Laeger. 177 (12). PMID 25786843.
  8. Clinical and laboratory findings of Hepatic adenoma. Scielo 2015. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-67202013000300012&lng=en&nrm=iso&tlng=en. Accessed on October 16, 2015
  9. Toso C, Majno P, Andres A, Rubbia-Brandt L, Berney T, Buhler L, Morel P, Mentha G (2005). "Management of hepatocellular adenoma: solitary-uncomplicated, multiple and ruptured tumors". World J Gastroenterol. 11 (36): 5691–5. PMID 16237767.Full text


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