Hepatocellular adenoma overview: Difference between revisions
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==Overview== | ==Overview== | ||
'''Hepatocellular adenoma''' is an uncommon benign [[liver]] tumor 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 was first discovered by Hugh A. Edmondson in 1958 following 50,000 autopsies. It may be classified into four subtypes based on the rate of occurence such as inflammatory hepatic adenoma, ''HNF1-alpha'' mutated hepatic adenoma, ''Beta-catenin'' mutated hepatic adenoma and unclassified hepatocellular adenoma. On gross pathology, well circumscribed, nonlobulated, smooth and soft, white to yellow to brown lesions are findings of a solitary hepatocellular adenoma. There are no established causes for it. The incidence of hepatic adenoma is approximately 3 per 100,000 individuals worldwide. The most potent risk factor in the development of hepatocellular adenoma is use of oral contraceptive pills. According to the American Association for the Study of Liver Diseases and United States Preventive Services Task Force, there is insufficient evidence to recommend routine screening for hepatocellular adenoma. It must be differentiated from other diseases such as [[hepatocellular carcinoma]], [[focal nodular hyperplasia]], [[liver metastases]] (hypervascular), [[haemangioma]] of the liver, [[fibrolamellar hepatocellular carcinoma]]. If left untreated, 30% of patients with hepatocellular adenoma may progress to develop risk of bleeding. It's common complications includes spontaneous rupture, haemorrhage and malignant transformation to hepatocellular carcinoma. | '''Hepatocellular adenoma''' is an uncommon benign [[liver]] tumor 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 was first discovered by Hugh A. Edmondson in 1958 following 50,000 autopsies. It may be classified into four subtypes based on the rate of occurence such as inflammatory hepatic adenoma, ''HNF1-alpha'' mutated hepatic adenoma, ''Beta-catenin'' mutated hepatic adenoma and unclassified hepatocellular adenoma. On gross pathology, well circumscribed, nonlobulated, smooth and soft, white to yellow to brown lesions are findings of a solitary hepatocellular adenoma. HCA is usually solitary (70-80%) and multiple in 20-30%. There are no established causes for it. The incidence of hepatic adenoma is approximately 3 per 100,000 individuals worldwide. The most potent risk factor in the development of hepatocellular adenoma is use of oral contraceptive pills. According to the American Association for the Study of Liver Diseases and United States Preventive Services Task Force, there is insufficient evidence to recommend routine screening for hepatocellular adenoma. It must be differentiated from other diseases such as [[hepatocellular carcinoma]], [[focal nodular hyperplasia]], [[liver metastases]] (hypervascular), [[haemangioma]] of the liver, [[fibrolamellar hepatocellular carcinoma]]. If left untreated, 30% of patients with hepatocellular adenoma may progress to develop risk of bleeding. It's common complications includes spontaneous rupture, haemorrhage and malignant transformation to hepatocellular carcinoma. | ||
==Historical Perspective== | ==Historical Perspective== | ||
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> | ||
Revision as of 16:57, 2 November 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 tumor which is associated with the use of hormonal contraception with a high estrogen content.[1] Hepatocellular adenoma was first discovered by Hugh A. Edmondson in 1958 following 50,000 autopsies. It may be classified into four subtypes based on the rate of occurence such as inflammatory hepatic adenoma, HNF1-alpha mutated hepatic adenoma, Beta-catenin mutated hepatic adenoma and unclassified hepatocellular adenoma. On gross pathology, well circumscribed, nonlobulated, smooth and soft, white to yellow to brown lesions are findings of a solitary hepatocellular adenoma. HCA is usually solitary (70-80%) and multiple in 20-30%. There are no established causes for it. The incidence of hepatic adenoma is approximately 3 per 100,000 individuals worldwide. The most potent risk factor in the development of hepatocellular adenoma is use of oral contraceptive pills. According to the American Association for the Study of Liver Diseases and United States Preventive Services Task Force, there is insufficient evidence to recommend routine screening for hepatocellular adenoma. It must be differentiated from other diseases such as hepatocellular carcinoma, focal nodular hyperplasia, liver metastases (hypervascular), haemangioma of the liver, fibrolamellar hepatocellular carcinoma. If left untreated, 30% of patients with hepatocellular adenoma may progress to develop risk of bleeding. It's common complications includes spontaneous rupture, haemorrhage and malignant transformation to hepatocellular carcinoma.
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 the rate of occurence, inflammatory hepatic adenoma, HNF1-alpha mutated hepatic adenoma, Beta catenin-mutated hepatic adenoma and unclassified hepatocellular adenoma. [3]
Pathophysiology
On gross pathology, well circumscribed, nonlobulated, smooth and soft, white to yellow to brown lesions are findings of a solitary hepatocellular adenoma.[4] [2]
Causes
There are no established causes for hepatocellular adenoma.
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][2]
Screening
According to the American Association for the Study of Liver Diseases and 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, focal nodular hyperplasia, 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 and malignant transformation to Hepatocellular carcinoma.[7][3][7]
Diagnosis
History and Symptoms
Hepatocellular adenoma can present as right upper quadrant abdominal pain, acute abdomen or life threatening bleeding.[2]
Physical Examination
Laboratory Findings
An elevated concentration of serum alkaline phosphatase and gamma glutamyl transferase may be present in patients with Hepatocellular adenoma.[8]
Chest X Ray
There are no chest x-ray findings associated with hepatocellular adenoma.
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
All hepatocellular adenoma should be surgically resected, because of the risk of rupture causing bleeding and because they may contain malignant foci.[9]
Primary Prevention
Secondary Prevention
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