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==Overview== | ==Overview== | ||
'''Hepatocellular adenoma''' is an uncommon benign [[liver]] tumour which is associated with the use 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''' is an uncommon benign [[liver]] tumour which is associated with the use 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> | ||
==Historical Perspective== | |||
Hepatocellular adenoma was first discovered by 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 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== | |||
Hepatocellular adenoma may be classified into four subtypes based on rate of occurence.<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.<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== | |||
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> | ||
==Causes== | |||
The most common cause of hepatocellular adenoma is [[oral contraceptive]] use.<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> | The most common cause of hepatocellular adenoma is [[oral contraceptive]] use.<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> | ||
==Epidemiology and Demographics== | |||
The incidence of hepatic adenoma is approximately 3 per 100,000 individuals worldwide.<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> | The incidence of hepatic adenoma is approximately 3 per 100,000 individuals worldwide.<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> | ||
==Risk factors== | |||
The most potent risk factor in the development of hepatocellular adenoma is use of oral contraceptive pills.<ref name=risk>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</ref> | The most potent risk factor in the development of hepatocellular adenoma is use of oral contraceptive pills.<ref name=risk>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</ref> | ||
==Screening== | |||
According to the United States Preventive Services Task Force, there is insufficient evidence to recommend routine screening for hepatocellular adenoma.<ref name=abc>Hepatocellular adenoma. USPSTF. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=hepatocellular+adenoma</ref> | According to the United States Preventive Services Task Force, there is insufficient evidence to recommend routine screening for hepatocellular adenoma.<ref name=abc>Hepatocellular adenoma. USPSTF. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=hepatocellular+adenoma</ref> | ||
==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.<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 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.<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> | ||
==Natural History, Complications and Prognosis== | |||
If left untreated, 30% of patients with hepatocellular adenoma may progress to develop risk of bleeding.<ref name=abc>Hepatocellular adenoma.Wikipedia 2015. https://en.wikipedia.org/wiki/Hepatocellular_adenoma Accessed on October 16, 2015 </ref>Common complication of Hepatocellular adenoma includes spontaneous rupture, haemorrhage<ref name=a>{{cite web | title = Radiopedia 2015 Hepatic adenoma [Dr Matt A. Morgan and Dr Koshy Jacob]| url = http://radiopaedia.org/articles/hepatic-adenoma }}</ref><ref name="pmid25786843">{{cite journal| author=Aamann L, Schultz N, Fallentin E, Hamilton-Dutoit S, Vogel I, Grønbæk H| title=[Hepatocellular adenoma - new classification and recommendations]. | journal=Ugeskr Laeger | year= 2015 | volume= 177 | issue= 12 | pages= | pmid=25786843 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25786843 }} </ref>and malignant transformation to Hepatocellular carcinoma.<ref name="pmid25786843">{{cite journal| author=Aamann L, Schultz N, Fallentin E, Hamilton-Dutoit S, Vogel I, Grønbæk H| title=[Hepatocellular adenoma - new classification and recommendations]. | journal=Ugeskr Laeger | year= 2015 | volume= 177 | issue= 12 | pages= | pmid=25786843 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25786843 }} </ref> | If left untreated, 30% of patients with hepatocellular adenoma may progress to develop risk of bleeding.<ref name=abc>Hepatocellular adenoma.Wikipedia 2015. https://en.wikipedia.org/wiki/Hepatocellular_adenoma Accessed on October 16, 2015 </ref>Common complication of Hepatocellular adenoma includes spontaneous rupture, haemorrhage<ref name=a>{{cite web | title = Radiopedia 2015 Hepatic adenoma [Dr Matt A. Morgan and Dr Koshy Jacob]| url = http://radiopaedia.org/articles/hepatic-adenoma }}</ref><ref name="pmid25786843">{{cite journal| author=Aamann L, Schultz N, Fallentin E, Hamilton-Dutoit S, Vogel I, Grønbæk H| title=[Hepatocellular adenoma - new classification and recommendations]. | journal=Ugeskr Laeger | year= 2015 | volume= 177 | issue= 12 | pages= | pmid=25786843 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25786843 }} </ref>and malignant transformation to Hepatocellular carcinoma.<ref name="pmid25786843">{{cite journal| author=Aamann L, Schultz N, Fallentin E, Hamilton-Dutoit S, Vogel I, Grønbæk H| title=[Hepatocellular adenoma - new classification and recommendations]. | journal=Ugeskr Laeger | year= 2015 | volume= 177 | issue= 12 | pages= | pmid=25786843 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25786843 }} </ref> | ||
==Diagnosis== | |||
Hepatocellular adenoma can present as right upper quadrant pain, acute abdomen or life threatening bleeding.<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>An elevated concentration of serum alkaline phosphatase and gamma glutamyl transferase may be present in patients with Hepatocellular adenoma.<ref name=fgh>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</ref> | Hepatocellular adenoma can present as right upper quadrant pain, acute abdomen or life threatening bleeding.<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>An elevated concentration of serum alkaline phosphatase and gamma glutamyl transferase may be present in patients with Hepatocellular adenoma.<ref name=fgh>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</ref> | ||
==Treatment== | |||
All hepatocellular adenoma should be surgically resected, because of the risk of rupture causing bleeding and because they may contain malignant foci.<ref name=cde>{{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> | All hepatocellular adenoma should be surgically resected, because of the risk of rupture causing bleeding and because they may contain malignant foci.<ref name=cde>{{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> | ||
Revision as of 14:22, 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 Edmondson in 1958 following 50,000 autopsies.[2]
Classification
Hepatocellular adenoma may be classified into four subtypes based on rate of occurence.[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
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
All hepatocellular adenoma should be surgically resected, because of the risk of rupture causing bleeding and because they may contain malignant foci.[9]
References
- ↑ 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.
- ↑ 2.0 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.
- ↑ 3.0 3.1 3.2 Radiopaedia 2015 Hepatic adenoma>"Radiopedia 2015 Hepatic adenoma [Dr Matt A. Morgan and Dr Koshy Jacob]".
- ↑ 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.
- ↑ 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
- ↑ 6.0 6.1 Hepatocellular adenoma. USPSTF. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=hepatocellular+adenoma
- ↑ 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.
- ↑ 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
- ↑ 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