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{{Infobox_Disease | 
__NOTOC__
Name          = {{PAGENAME}} | 
'''For patient information, click [[Hepatocellular adenoma (patient information)|here]]'''
Image          = | 
Caption        = | 
DiseasesDB    = 5726 | 
ICD10          = | 
ICD9          = | 
ICDO          = {{ICDO|8170|0}} | 
OMIM          = | 
MedlinePlus    = | 
eMedicineSubj  = med | 
eMedicineTopic = 48 | 
MeshID        = D018248 |  
}}
{{SI}}
{{CMG}}


'''Contributors:'''  [[User:zorkun|Cafer Zorkun]] M.D., PhD.
{{Hepatocellular adenoma}}
{{CMG}}; {{AE}} {{ZAS}}{{Sab}}


{{Editor Help}}
{{SK}} Hepadenoma; Hepatic adenoma; Liver cell adenoma; Liver adenoma; Liver cell adenomatosis; Hepatocyte adenoma; Inflammatory hepatic adenoma; ''HNF1-alpha'' mutated hepatic adenoma; ''Beta-catenin'' mutated hepatic adenoma; Hepatocyte benign tumor; Unclassified hepatocellular adenoma; Inflammatory hepatocellular adenoma; ''HNF1-alpha'' mutated hepatocellular adenoma; ''Beta-catenin'' mutated hepatocellular adenoma; Unclassified hepatic adenoma


==Overview==
==[[Hepatocellular adenoma overview|Overview]]==


'''Hepatocellular adenoma''', also '''hepatic adenoma''', or rarely '''hepadenoma''', is an uncommon benign [[liver]] tumour which is associated with the use of types of [[hormonal contraception]] with a high [[Estrogen|estrogen]] content.<ref>{{cite journal | author = Rooks J, Ory H, Ishak K, Strauss L, Greenspan J, Hill A, Tyler C | title = Epidemiology of hepatocellular adenoma. The role of oral contraceptive use. | journal = JAMA | volume = 242 | issue = 7 | pages = 644-8 | year = 1979 | id = PMID 221698}}</ref>
==[[Hepatocellular adenoma historical perspective|Historical Perspective]]==


==Diagnosis==
==[[Hepatocellular adenoma classification|Classification]]==


[[MRI]] is the most useful investigation in the diagnosis and workup.<ref>{{cite journal | author = Hussain S, van den Bos I, Dwarkasing R, Kuiper J, den Hollander J | title = Hepatocellular adenoma: findings at state-of-the-art magnetic resonance imaging, ultrasound, computed tomography and pathologic analysis. | journal = Eur Radiol | volume = 16 | issue = 9 | pages = 1873-86 | year = 2006 | id = PMID 16708218}}</ref>
==[[Hepatocellular adenoma pathophysiology|Pathophysiology]]==


==Diagnostic Findings==
==[[Hepatocellular adenoma causes|Causes]]==


===Ultrasonography===
==[[Hepatocellular adenoma epidemiology and demographics|Epidemiology and Demographics]]==


* Color Doppler US may demonstrate peripheral peritumoral vessels and intratumoral vessels that typically have a flat continuous or, less commonly, triphasic waveform.  *These Doppler US features are reported to be absent in the vessels within focal nodular hyperplasia and may be useful in distinguishing the two disease entities.  *Nevertheless, most adenomas are not specifically diagnosed at US and are usually further evaluated with CT or other imaging modalities.
==[[Hepatocellular adenoma risk factors|Risk Factors]]==


===Computed Tomography===
==[[Hepatocellular adenoma screening|Screening]]==


* Fat or hemorrhage can easily be identified on unenhanced images, and delayed-phase images demonstrate the tendency for fibrotic components to enhance and retain contrast material.
==[[Hepatocellular adenoma differential diagnosis|Differentiating Hepatocellular adenoma from other Diseases]]==


* Because adenomas consist almost entirely of uniform hepatocytes and a variable number of Kupffer cells, most adenomas are nearly isoattenuating relative to normal liver on unenhanced, portal venous–phase, and delayed-phase images.
==[[Hepatocellular adenoma natural history|Natural History, Complications and Prognosis]]==


* In patients with fatty liver, adenomas are hyperattenuating at all phases of contrast enhancement and on unenhanced images as well.
==Diagnosis==
 
[[Hepatocellular adenoma history and symptoms|History and Symptoms]] | [[Hepatocellular adenoma physical examination|Physical Examination]] | [[Hepatocellular adenoma laboratory tests|Laboratory Findings]] | [[Hepatocellular adenoma chest x ray|Chest X Ray]] | [[Hepatocellular adenoma CT|CT]] | [[Hepatocellular adenoma MRI|MRI]] | [[Hepatocellular adenoma ultrasound|Ultrasound]] | [[Hepatocellular adenoma other imaging findings|Other Imaging Findings]] | [[Hepatocellular adenoma other diagnostic studies|Other Diagnostic Studies]]
* Small hepatocellular adenomas enhance rapidly and are hyperattenuating relative to the liver.
 
* Excluding lesions with acute or old tumor hemorrhage and fat deposition, hepatocellular adenoma demonstrated homogeneous or nearly homogeneous enhancement in approx 80% of cases.
 
** The enhancement usually does not persist in adenomas because of arteriovenous shunting.
 
* Larger hepatocellular adenomas may be more heterogeneous than smaller lesions, and their CT appearance is less specific.
 
===Magnetic Resonance Imaging===
 
* On T1-weighted MR images, hepatocellular adenomas have been variously described as hyperintense, isointense, and hypointense lesions.
 
* It has been reported that 47%–74% of hepatocellular adenomas are predominantly hyperintense relative to liver on T2-weighted images; this is due to prolonged T2 and is consistent with findings in other hepatic tumors.
 
* Some lesions are hypointense and isointense on T2-weighted images.
 
* Most lesions are heterogeneous, demonstrating a combination of hyper- and hypointensity on T2-weighted images relative to hemorrhage and necrosis.
 
*Dynamic gadolinium-enhanced gradient-echo MR imaging, like dynamic CT, can be used to demonstrate early arterial enhancement that reflects the presence of subcapsular feeding vessels.
 
*Adenomas usually do not show uptake of superparamagnetic iron oxide particles, resulting in decreased signal intensity on T2-weighted images.
 
*After injection of a hepatocellular-specific contrast agent such as gadolinium benzyloxypropionictetraacetate (Gd-BOPTA) there is usually no substantial uptake.
 
===Nuclear Scintigraphy===
 
* Compared with normal liver, adenomas usually show absent or decreased uptake of Tc-99m sulfur colloid, reflecting the decreased number or function of Kupffer cells.
 
[http://www.radswiki.net Images courtesy of RadsWiki]
 
<gallery perRow="3">
 
Image:Hepatic ademona CT 001.jpg|CT portal venous phase: A patient with multiple adenoma
 
Image:Hepatic ademona CT 002.jpg|CT portal venous phase: A patient with multiple adenoma
 
Image:Hepatic ademona MRI 003.jpg|T2 SSFSE: A patient with multiple adenoma
 
Image:Hepatic ademona MRI 004.jpg|T2 SSFSE: A patient with multiple adenoma
 
Image:Hepatic ademona MRI 005.jpg|T2 Fat sat: A patient with multiple adenoma
 
Image:Hepatic ademona MRI 006.jpg|In phase: A patient with multiple adenoma
 
Image:Hepatic ademona MRI 007.jpg|Out of phase: A patient with multiple adenoma
 
Image:Hepatic ademona MRI 008.jpg|T1 fat sat: A patient with multiple adenoma
 
Image:Hepatic ademona MRI 009.jpg|T1 fat sat arterial: A patient with multiple adenoma
 
Image:Hepatic ademona MRI 010.jpg|T1 fat sat arterial: A patient with multiple adenoma
 
Image:Hepatic ademona MRI 011.jpg|T1 fat sat delayed: A patient with multiple adenoma
 
Image:Hepatic ademona MRI 012.jpg|T1 fat sat delayed: A patient with multiple adenoma
 
</gallery>


==Treatment==
==Treatment==
 
[[Hepatocellular adenoma medical therapy|Medical Therapy]] | [[Hepatocellular adenoma surgery|Surgery]] | [[Hepatocellular adenoma primary prevention|Primary Prevention]] | [[Hepatocellular adenoma secondary prevention|Secondary Prevention]] | [[Hepatocellular adenoma cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Hepatocellular adenoma future or investigational therapies|Future or Investigational Therapies]]
All hepatocellular adenoma should be surgically resected, because of the risk of rupture causing bleeding and because they may contain malignant foci.<ref>{{cite journal | author = Toso C, Majno P, Andres A, Rubbia-Brandt L, Berney T, Buhler L, Morel P, Mentha G | title = Management of hepatocellular adenoma: solitary-uncomplicated, multiple and ruptured tumors. | journal = World J Gastroenterol | volume = 11 | issue = 36 | pages = 5691-5 | year = 2005 | id = PMID 16237767}}''[http://www.wjgnet.com/1007-9327/11/5691.asp Full text]''</ref>
 
==References==
{{reflist|2}}
 


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Latest revision as of 02:25, 1 September 2019

For patient information, click here

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zahir Ali Shaikh, MD[2]Sabawoon Mirwais, M.B.B.S, M.D.[3]

Synonyms and keywords: Hepadenoma; Hepatic adenoma; Liver cell adenoma; Liver adenoma; Liver cell adenomatosis; Hepatocyte adenoma; Inflammatory hepatic adenoma; HNF1-alpha mutated hepatic adenoma; Beta-catenin mutated hepatic adenoma; Hepatocyte benign tumor; Unclassified hepatocellular adenoma; Inflammatory hepatocellular adenoma; HNF1-alpha mutated hepatocellular adenoma; Beta-catenin mutated hepatocellular adenoma; Unclassified hepatic adenoma

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Epidemiology and Demographics

Risk Factors

Screening

Differentiating Hepatocellular adenoma from other Diseases

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Chest X Ray | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

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