Hepatocellular adenoma (patient information): Difference between revisions
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'''For the WikiDoc page on this topic, click [[Hepatocellular adenoma|here]]''' | '''For the WikiDoc page on this topic, click [[Hepatocellular adenoma|here]]''' | ||
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==What are the symptoms of Hepatocellular adenoma?== | ==What are the symptoms of Hepatocellular adenoma?== | ||
Small [[hepatocellular adenoma|hepatocellular adenomas]] are generally [[asymptomatic]]. | Small [[hepatocellular adenoma|hepatocellular adenomas]] are generally [[asymptomatic]]. | ||
* [[Abdominal pain]] is the most common presenting [[symptom]] in some [[Patient|patients]], and the pain is usually related to [[Tumor|tumoral]] [[hemorrhage]]. | * [[Abdominal pain]] is the most common presenting [[symptom]] in some [[Patient|patients]], and the pain is usually related to [[Tumor|tumoral]] [[hemorrhage]]. | ||
* [[Right upper quadrant]] [[Abdomen|abdominal]] fullness or [[discomfort]] is present in 40% of cases due to [[mass]] effect. | * [[Right upper quadrant]] [[Abdomen|abdominal]] fullness or [[discomfort]] is present in 40% of cases due to [[mass]] effect. | ||
* Eventually, spontaneous [[rupture]] or [[hemorrhage]] may occur, leading to [[acute abdominal pain]] with progression to [[hypotension]] and even death. | * Eventually, spontaneous [[rupture]] or [[hemorrhage]] may occur, leading to [[acute abdominal pain]] with progression to [[hypotension]] and even death. | ||
* Patients with hepatocellular adenomas typically have a history of [[Oral contraceptive|oral contraceptive use]] (females) and long term [[anabolic]] [[steroids]] use (males). | * Patients with hepatocellular adenomas typically have a history of [[Oral contraceptive|oral contraceptive use]] (females) and long term [[anabolic]] [[steroids]] use (males). | ||
==What causes Hepatocellular adenoma?== | ==What causes Hepatocellular adenoma?== | ||
* The [[Causality|causes]] of [[hepatocellular adenoma]] include; | * The [[Causality|causes]] of [[hepatocellular adenoma]] include; | ||
** [[Oral contraceptive|Oral contraceptive medications]] | ** [[Oral contraceptive|Oral contraceptive medications]] | ||
*** The [[Causality|causal]] relationship is proportional to the [[Hormone|hormonal]] [[dose]] and duration of [[medication]], highest in women over 30 years of [[age]] and after 24 months of using [[Oral contraceptive|oral contraceptives]]. | *** The [[Causality|causal]] relationship is proportional to the [[Hormone|hormonal]] [[dose]] and duration of [[medication]], highest in women over 30 years of [[age]] and after 24 months of using [[Oral contraceptive|oral contraceptives]]. | ||
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==Who is at highest risk?== | ==Who is at highest risk?== | ||
* The most important [[risk factor]] in the development of [[hepatocellular adenoma]] is use of [[Oral contraceptive|oral contraceptive medications]]. | * The most important [[risk factor]] in the development of [[hepatocellular adenoma]] is use of [[Oral contraceptive|oral contraceptive medications]]. | ||
:*[[Drospirenone and Ethinyl estradiol]] | :*[[Drospirenone and Ethinyl estradiol]] | ||
:*[[Norethindrone acetate and Ethinyl estradiol]] | :*[[Norethindrone acetate and Ethinyl estradiol]] | ||
| Line 173: | Line 41: | ||
::* [[Hormone|Hormonal]] [[dose]] | ::* [[Hormone|Hormonal]] [[dose]] | ||
::* Duration of [[medication]] | ::* Duration of [[medication]] | ||
* Other [[Risk factor|risk factors]] include:<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 | * Other [[Risk factor|risk factors]] include:<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> | ||
}}</ref> | |||
:* [[Clomiphene]] | :* [[Clomiphene]] | ||
:* [[Methyltestosterone]] | :* [[Methyltestosterone]] | ||
| Line 212: | Line 50: | ||
==Risk factors for malignant transformation== | ==Risk factors for malignant transformation== | ||
The [[risk factor]] for [[malignant transformation]] of [[Hepatocellular adenoma|hepatic adenoma]] to [[hepatocellular carcinoma]] is: | The [[risk factor]] for [[malignant transformation]] of [[Hepatocellular adenoma|hepatic adenoma]] to [[hepatocellular carcinoma]] is: | ||
:* Gender (men) | :* Gender (men) | ||
:* Size (> 8 cm) | :* Size (> 8 cm) | ||
| Line 229: | Line 67: | ||
An annual follow-up with MRI or ultrasound is scheduled for patients untill menopause.[4][5][6][7][8][9][10] | An annual follow-up with MRI or ultrasound is scheduled for patients untill menopause.[4][5][6][7][8][9][10] | ||
===Surgical Therapy=== | ===Surgical Therapy=== | ||
*[[Surgery]] is the treatment of choice for [[hepatocellular adenoma]], as it can achieved in a controlled and safe manner.<ref>{{Cite journal | |||
| author = [[Paulette Bioulac-Sage]], [[Herve Laumonier]], [[Gabrielle Couchy]], [[Brigitte Le Bail]], [[Antonio Sa Cunha]], [[Anne Rullier]], [[Christophe Laurent]], [[Jean-Frederic Blanc]], [[Gaelle Cubel]], [[Herve Trillaud]], [[Jessica Zucman-Rossi]], [[Charles Balabaud]] & [[Jean Saric]] | |||
| title = Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience | |||
| journal = [[Hepatology (Baltimore, Md.)]] | |||
| volume = 50 | |||
| issue = 2 | |||
| pages = 481–489 | |||
| year = 2009 | |||
| month = August | |||
| doi = 10.1002/hep.22995 | |||
| pmid = 19585623 | |||
}}</ref><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><ref name="pmid8813164">{{cite journal| author=Ault GT, Wren SM, Ralls PW, Reynolds TB, Stain SC| title=Selective management of hepatic adenomas. | journal=Am Surg | year= 1996 | volume= 62 | issue= 10 | pages= 825-9 | pmid=8813164 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8813164 }}</ref> | |||
*Elective [[Surgery|surgical]] [[resection]] of [[hepatocellular adenoma]] is considered for all [[adenoma]] [[Lesion|lesions]] >5cm in [[diameter]], [[Lesion|lesions]] that increase in size, [[Lesion|lesions]] with [[Tumoral|intratumoral]] [[hemorrhage]] and male patients (irrespective of [[adenoma]] size).<ref>{{Cite journal | |||
| author = [[T. Terkivatan]], [[J. H. de Wilt]], [[R. A. de Man]], [[R. R. van Rijn]], [[H. W. Tilanus]] & [[J. N. IJzermans]] | |||
| title = Treatment of ruptured hepatocellular adenoma | |||
| journal = [[The British journal of surgery]] | |||
| volume = 88 | |||
| issue = 2 | |||
| pages = 207–209 | |||
| year = 2001 | |||
| month = February | |||
| doi = 10.1046/j.1365-2168.2001.01648.x | |||
| pmid = 11167868 | |||
}}</ref><ref>{{Cite journal | |||
| author = [[J. Belghiti]], [[D. Pateron]], [[Y. Panis]], [[V. Vilgrain]], [[J. F. Flejou]], [[J. P. Benhamou]] & [[F. Fekete]] | |||
| title = Resection of presumed benign liver tumours | |||
| journal = [[The British journal of surgery]] | |||
| volume = 80 | |||
| issue = 3 | |||
| pages = 380–383 | |||
| year = 1993 | |||
| month = March | |||
| pmid = 8472159 | |||
}}</ref> | |||
*[[Liver transplantation]] may be considered for patients of [[hepatocellular adenoma]] associated with [[Glycogen storage disease type I|glycogen storage disease type 1]].<ref>{{Cite journal | |||
| author = [[Jan P. Lerut]], [[Olga Ciccarelli]], [[Christine Sempoux]], [[Etienne Danse]], [[Jacques deFlandre]], [[Yves Horsmans]], [[Etienne Sokal]] & [[Jean-Bernard Otte]] | |||
| title = Glycogenosis storage type I diseases and evolutive adenomatosis: an indication for liver transplantation | |||
| journal = [[Transplant international : official journal of the European Society for Organ Transplantation]] | |||
| volume = 16 | |||
| issue = 12 | |||
| pages = 879–884 | |||
| year = 2003 | |||
| month = December | |||
| doi = 10.1007/s00147-003-0613-3 | |||
| pmid = 12904843 | |||
}}</ref> | |||
*In adenoma patients who are poor candidates for [[surgery]] (centrally located [[Lesion|lesions]], multiple [[Adenoma|adenomas]], [[morbid obesity]]), [[Radiofrequency ablation|radiofrequency ablation (RFA)]] and transcatheter [[Artery|arterial]] [[embolization]] (TAE) may be considered. | |||
*[[Radiofrequency ablation|Radiofrequency ablation (RFA)]] is a minimally [[Invasive (medical)|invasive]] technique that can be used for [[Hepatocellular adenoma|hepatocellular adenomas]], [[hepatocellular carcinoma]] and [[colorectal]] [[Metastasis|metastases]] as well.<ref>{{Cite journal | |||
| author = [[Maarten G. Thomeer]], [[Mirelle Broker]], [[Joanne Verheij]], [[Michael Doukas]], [[Turkan Terkivatan]], [[Diederick Bijdevaate]], [[Robert A. De Man]], [[Adriaan Moelker]] & [[Jan N. IJzermans]] | |||
| title = Hepatocellular adenoma: when and how to treat? Update of current evidence | |||
| journal = [[Therapeutic advances in gastroenterology]] | |||
| volume = 9 | |||
| issue = 6 | |||
| pages = 898–912 | |||
| year = 2016 | |||
| month = November | |||
| doi = 10.1177/1756283X16663882 | |||
| pmid = 27803743 | |||
}}</ref> | |||
*[[Transcatheter arterial chemoembolization|Transcatheter arterial embolization]] ([[Transcatheter arterial chemoembolization|TAE]]) is used in [[adenoma]] patients with [[hemodynamic instability]] due to [[bleeding]] hypervascular [[Artery|arterial]] lesions. | |||
==Where to find medical care for Hepatocellular adenoma?== | ==Where to find medical care for Hepatocellular adenoma?== | ||
| Line 257: | Line 155: | ||
[[Category:Surgery]] | [[Category:Surgery]] | ||
[[Category:Hepatology]] | [[Category:Hepatology]] | ||
<references /> | |||
Revision as of 16:28, 1 February 2019
For the WikiDoc page on this topic, click here
|
Hepatocellular adenoma |
|
Hepatocellular adenoma On the Web |
|---|
|
Risk calculators and risk factors for Hepatocellular adenoma |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]
Overview
What are the symptoms of Hepatocellular adenoma?
Small hepatocellular adenomas are generally asymptomatic.
- Abdominal pain is the most common presenting symptom in some patients, and the pain is usually related to tumoral hemorrhage.
- Right upper quadrant abdominal fullness or discomfort is present in 40% of cases due to mass effect.
- Eventually, spontaneous rupture or hemorrhage may occur, leading to acute abdominal pain with progression to hypotension and even death.
- Patients with hepatocellular adenomas typically have a history of oral contraceptive use (females) and long term anabolic steroids use (males).
What causes Hepatocellular adenoma?
- The causes of hepatocellular adenoma include;
- Oral contraceptive medications
- The causal relationship is proportional to the hormonal dose and duration of medication, highest in women over 30 years of age and after 24 months of using oral contraceptives.
- Pregnancy
- Glycogen storage disease types I,II and IV
- Long term use of anabolic androgenic steroids
- Metabolic syndrome
- Maturity onset diabetes of young (MODY)
- Obesity
- Clomiphene
- Familial adenomatous polyposis
- Vascular disorders such as portal vein agenesis, Budd-Chiari syndrome and hereditary hemorrhagic telangiectasia.
- Oral contraceptive medications
Who is at highest risk?
- The most important risk factor in the development of hepatocellular adenoma is use of oral contraceptive medications.
- Drospirenone and Ethinyl estradiol
- Norethindrone acetate and Ethinyl estradiol
- Norgestimate and Ethinyl estradiol
- Norgestrel and Ethinyl estradiol
- The risk is proportional to:[1]
- Hormonal dose
- Duration of medication
- Other risk factors include:[1]
Risk factors for malignant transformation
The risk factor for malignant transformation of hepatic adenoma to hepatocellular carcinoma is:
- Gender (men)
- Size (> 8 cm)
- Subtype (beta-catenin-activated HCA)
Diagnosis
When to seek urgent medical care?
Treatment options
Medical Therapy
There is no specific medical therapy for the hepatocellular adenoma.[1][2] Historically, hepatocellular adenomas were treated with a wait and watch policy, with surgical intervention recommended for larger (>5cm) tumors. In asymptomatic female patients suffering from hepatocellular adenomas, the first step is to stop the offending drug (such as OCPs) and check adenoma size on follow-up. The wait and watch policy is recommended when hepatocellular adenomas are <5cm or regress (to <5cm) following cessation of offending drug (OCPs) and no further growth is detected.[3] An annual follow-up with MRI or ultrasound is scheduled for patients untill menopause.[4][5][6][7][8][9][10]
Surgical Therapy
- Surgery is the treatment of choice for hepatocellular adenoma, as it can achieved in a controlled and safe manner.[2][3][4]
- Elective surgical resection of hepatocellular adenoma is considered for all adenoma lesions >5cm in diameter, lesions that increase in size, lesions with intratumoral hemorrhage and male patients (irrespective of adenoma size).[5][6]
- Liver transplantation may be considered for patients of hepatocellular adenoma associated with glycogen storage disease type 1.[7]
- In adenoma patients who are poor candidates for surgery (centrally located lesions, multiple adenomas, morbid obesity), radiofrequency ablation (RFA) and transcatheter arterial embolization (TAE) may be considered.
- Radiofrequency ablation (RFA) is a minimally invasive technique that can be used for hepatocellular adenomas, hepatocellular carcinoma and colorectal metastases as well.[8]
- Transcatheter arterial embolization (TAE) is used in adenoma patients with hemodynamic instability due to bleeding hypervascular arterial lesions.
Where to find medical care for Hepatocellular adenoma?
Directions to Hospitals Treating Hepatocellular adenoma
Prevention of Hepatocellular adenoma
What to expect (Outlook/Prognosis)?
Possible complications
Source
- ↑ 1.0 1.1 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.
- ↑ Paulette Bioulac-Sage, Herve Laumonier, Gabrielle Couchy, Brigitte Le Bail, Antonio Sa Cunha, Anne Rullier, Christophe Laurent, Jean-Frederic Blanc, Gaelle Cubel, Herve Trillaud, Jessica Zucman-Rossi, Charles Balabaud & Jean Saric (2009). "Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience". Hepatology (Baltimore, Md.). 50 (2): 481–489. doi:10.1002/hep.22995. PMID 19585623. Unknown parameter
|month=ignored (help) - ↑ 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
- ↑ Ault GT, Wren SM, Ralls PW, Reynolds TB, Stain SC (1996). "Selective management of hepatic adenomas". Am Surg. 62 (10): 825–9. PMID 8813164.
- ↑ T. Terkivatan, J. H. de Wilt, R. A. de Man, R. R. van Rijn, H. W. Tilanus & J. N. IJzermans (2001). "Treatment of ruptured hepatocellular adenoma". The British journal of surgery. 88 (2): 207–209. doi:10.1046/j.1365-2168.2001.01648.x. PMID 11167868. Unknown parameter
|month=ignored (help) - ↑ J. Belghiti, D. Pateron, Y. Panis, V. Vilgrain, J. F. Flejou, J. P. Benhamou & F. Fekete (1993). "Resection of presumed benign liver tumours". The British journal of surgery. 80 (3): 380–383. PMID 8472159. Unknown parameter
|month=ignored (help) - ↑ Jan P. Lerut, Olga Ciccarelli, Christine Sempoux, Etienne Danse, Jacques deFlandre, Yves Horsmans, Etienne Sokal & Jean-Bernard Otte (2003). "Glycogenosis storage type I diseases and evolutive adenomatosis: an indication for liver transplantation". Transplant international : official journal of the European Society for Organ Transplantation. 16 (12): 879–884. doi:10.1007/s00147-003-0613-3. PMID 12904843. Unknown parameter
|month=ignored (help) - ↑ Maarten G. Thomeer, Mirelle Broker, Joanne Verheij, Michael Doukas, Turkan Terkivatan, Diederick Bijdevaate, Robert A. De Man, Adriaan Moelker & Jan N. IJzermans (2016). "Hepatocellular adenoma: when and how to treat? Update of current evidence". Therapeutic advances in gastroenterology. 9 (6): 898–912. doi:10.1177/1756283X16663882. PMID 27803743. Unknown parameter
|month=ignored (help)