Hepatocellular adenoma (patient information)

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Hepatocellular adenoma
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
Diagnosis
When to seek urgent medical care?
Treatment options
Where to find medical care for Hepatocellular adenoma?
Prevention
What to expect (Outlook/Prognosis)?
Possible complications
Hepatocellular adenoma On the Web
Ongoing Trials at Clinical Trials.gov
Images of Hepatocellular adenoma
Videos on Hepatocellular adenoma
FDA on Hepatocellular adenoma
CDC on Hepatocellular adenoma
Hepatocellular adenoma in the news
Blogs on Hepatocellular adenoma
Directions to Hospitals Treating Hepatocellular adenoma
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]

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
    • It appears to stimulate rapid growth in these lesions with the risk of potentially fatal spontaneous rupture.
  • 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.

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:

• Hormonal dose
• Duration of medication

• Other risk factors include:

• Clomiphene
• Methyltestosterone
• Danazol
• Klinefelter's syndrome
• Glycogen storage diseases I, II and IV.
• Familial adenomatous polyposis

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)

Treatment options

Medical Therapy

• There is no specific medical therapy for the hepatocellular adenoma.
• 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.
• An annual follow-up with MRI or ultrasound is scheduled for patients untill menopause.

Surgical Therapy

• Surgery is the treatment of choice for hepatocellular adenoma, as it can achieved in a controlled and safe manner.
• 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).
• Liver transplantation may be considered for patients of hepatocellular adenoma associated with glycogen storage disease type 1.
• 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.
• 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

What to expect (Outlook/Prognosis)?

• The prognosis is usually good for hepatocellular adenoma.
• When diagnosed, the discontinuation of oral contraception or androgen intake leads to regression of hepatocellular adenoma.
• In cases that do not regress after the withdrawal of oral contraception or androgen, surgical treatment is the management of choice.

Possible complications

• When left untreated, hepatic adenomas can rupture spontaneously. This can cause abdominal pain and internal bleeding. A ruptured hepatic adenoma requires immediate medical treatment.

• In rare cases, untreated hepatic adenomas can become cancerous. This is more likely when the tumor is large.

• Several studies suggest that β-catenin activated hepatic adenomas are more likely to become cancerous. Additional research is needed to understand the link between hepatic adenoma types and cancer.