Hepatocellular adenoma natural history, complications and prognosis: Difference between revisions

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==Overview==
==Overview==
There is 30% [[bleeding]] risk for [[hepatocellular adenoma]] if left untreated. The natural course of [[hepatocellular adenoma]] after cessation of [[Oral contraceptive|oral contraceptive use]] remains unclear, it may [[Regression|regress]] or remain stable in size. [[Complication (medicine)|Complications]] include [[bleeding]], [[rupture]] and [[malignant transformation]]. The [[prognosis]] is usually good after discontinuation of [[Oral contraceptive|oral contraceptives]], as it may [[Regression|regress]]. In cases where it does not [[Regression|regress]] after [[Oral contraceptive|oral contraception]] [[withdrawal]], [[surgery]] is the management of choice.
If left untreated, hepatocellular adenoma carries 30% [[bleeding]] risk.The natural course of hepatocellular adenoma after cessation of [[Oral contraceptive|oral contraceptive use]] remains unclear, it may [[Regression|regress]] or remain stable in size. [[Complication (medicine)|Complications]] include [[bleeding]], [[rupture]], and [[malignant transformation]]. The [[prognosis]] is usually good after discontinuation of [[Oral contraceptive|oral contraceptives]], as it may [[Regression|regress]]. In cases where it does not [[Regression|regress]] after [[Oral contraceptive|oral contraception]] [[withdrawal]], [[surgery]] is the management of choice.


==Natural history==
==Natural history, Complications, and Prognosis==
* The [[hepatocellular adenoma]] if left untreated, there is 30% [[bleeding]] risk.<ref>{{cite book | last = Fauci | first = Anthony | title = Harrison's principles of internal medicine | publisher = McGraw-Hill Medical | location = New York | year = 2008 | isbn = 978-0071466332 }}</ref>
 
* The natural course of [[hepatocellular adenoma]] after cessation of [[Oral contraceptive|oral contraceptive use]] remains unclear, it may [[Regression|regress]] or remain stable in size.<ref>{{Cite journal
=== Natural History ===
 
*If left untreated, hepatocellular adenoma carries 30% [[bleeding]] risk.<ref>{{cite book | last = Fauci | first = Anthony | title = Harrison's principles of internal medicine | publisher = McGraw-Hill Medical | location = New York | year = 2008 | isbn = 978-0071466332 }}</ref>
* The natural course of hepatocellular adenoma after cessation of [[Oral contraceptive|oral contraceptive use]] remains unclear, it may [[Regression|regress]] or remain stable in size.<ref>{{Cite journal
  | author = [[C. Bunchorntavakul]], [[R. Bahirwani]], [[D. Drazek]], [[M. C. Soulen]], [[E. S. Siegelman]], [[E. E. Furth]], [[K. Olthoff]], [[A. Shaked]] & [[K. R. Reddy]]
  | author = [[C. Bunchorntavakul]], [[R. Bahirwani]], [[D. Drazek]], [[M. C. Soulen]], [[E. S. Siegelman]], [[E. E. Furth]], [[K. Olthoff]], [[A. Shaked]] & [[K. R. Reddy]]
  | title = Clinical features and natural history of hepatocellular adenomas: the impact of obesity
  | title = Clinical features and natural history of hepatocellular adenomas: the impact of obesity
Line 21: Line 24:
  | pmid = 21762186
  | pmid = 21762186
}}</ref>
}}</ref>
* [[Obesity]] and [[metabolic syndrome]] may facilitate the progression of [[hepatocellular adenoma]], therefore [[weight loss]] may help in stability or [[regression]] of the [[lesion]].<ref>{{Cite journal
*[[Obesity]] and [[metabolic syndrome]] may facilitate the progression of hepatocellular adenoma, therefore [[weight loss]] may help in stability or [[regression]] of the [[lesion]].<ref>{{Cite journal
  | author = [[David Q. Wang]], [[Laurie M. Fiske]], [[Caroline T. Carreras]] & [[David A. Weinstein]]
  | author = [[David Q. Wang]], [[Laurie M. Fiske]], [[Caroline T. Carreras]] & [[David A. Weinstein]]
  | title = Natural history of hepatocellular adenoma formation in glycogen storage disease type I
  | title = Natural history of hepatocellular adenoma formation in glycogen storage disease type I
Line 34: Line 37:
}}</ref>
}}</ref>


==Complications==
===Complications===
* The [[Complication (medicine)|complications]] of [[hepatocellular adenoma]] include;<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><ref>{{Cite journal
 
* The [[Complication (medicine)|complications]] of hepatocellular adenoma include;<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><ref>{{Cite journal
  | author = [[Jeremiah L. Deneve]], [[Timothy M. Pawlik]], [[Steve Cunningham]], [[Bryan Clary]], [[Srinevas Reddy]], [[Charles R. Scoggins]], [[Robert C. G. Martin]], [[Michael D'Angelica]], [[Charles A. Staley]], [[Michael A. Choti]], [[William R. Jarnagin]], [[Richard D. Schulick]] & [[David A. Kooby]]
  | author = [[Jeremiah L. Deneve]], [[Timothy M. Pawlik]], [[Steve Cunningham]], [[Bryan Clary]], [[Srinevas Reddy]], [[Charles R. Scoggins]], [[Robert C. G. Martin]], [[Michael D'Angelica]], [[Charles A. Staley]], [[Michael A. Choti]], [[William R. Jarnagin]], [[Richard D. Schulick]] & [[David A. Kooby]]
  | title = Liver cell adenoma: a multicenter analysis of risk factors for rupture and malignancy
  | title = Liver cell adenoma: a multicenter analysis of risk factors for rupture and malignancy
Line 58: Line 62:
  | pmid = 27803743
  | pmid = 27803743
}}</ref><ref name="BunchorntavakulBahirwani2011">{{cite journal|last1=Bunchorntavakul|first1=C.|last2=Bahirwani|first2=R.|last3=Drazek|first3=D.|last4=Soulen|first4=M. C.|last5=Siegelman|first5=E. S.|last6=Furth|first6=E. E.|last7=Olthoff|first7=K.|last8=Shaked|first8=A.|last9=Reddy|first9=K. R.|title=Clinical features and natural history of hepatocellular adenomas: the impact of obesity|journal=Alimentary Pharmacology & Therapeutics|volume=34|issue=6|year=2011|pages=664–674|issn=02692813|doi=10.1111/j.1365-2036.2011.04772.x}}</ref>
}}</ref><ref name="BunchorntavakulBahirwani2011">{{cite journal|last1=Bunchorntavakul|first1=C.|last2=Bahirwani|first2=R.|last3=Drazek|first3=D.|last4=Soulen|first4=M. C.|last5=Siegelman|first5=E. S.|last6=Furth|first6=E. E.|last7=Olthoff|first7=K.|last8=Shaked|first8=A.|last9=Reddy|first9=K. R.|title=Clinical features and natural history of hepatocellular adenomas: the impact of obesity|journal=Alimentary Pharmacology & Therapeutics|volume=34|issue=6|year=2011|pages=664–674|issn=02692813|doi=10.1111/j.1365-2036.2011.04772.x}}</ref>
* '''[[Bleeding]] and [[rupture]]'''
** The presence of [[hepatocellular adenoma]] can be complicated by [[growth]] and [[rupture]].
** [[Bleeding]] in [[hepatocellular adenoma]] ranges from small [[subclinical]] [[bleed]] to life threatening [[intraperitoneal]] [[rupture]], resulting in [[hemorrhagic shock]] requiring [[emergency care]].
** [[Bleeding]] and [[rupture]] in [[hepatocellular adenoma]] are associated with [[tumor]] size and use of [[Oral contraceptive|oral contraceptives]].
** There is also increased risk of [[rupture]] in [[pregnancy]] because of increased [[hormone]] levels.
** The risk of [[rupture]] does not seem to be associated with [[tumor]] number.
** The risk of [[bleeding]] is directly correlated with size of [[tumor]] and > 5cm [[Hepatocellular adenoma|hepatocellular adenomas]] have a high risk of [[hemorrhage]].
* '''[[Malignant transformation]]'''
** The [[malignant transformation]] into [[hepatocellular carcinoma]] is a serious but [[rare]] [[Complication (medicine)|complication]] of [[hepatocellular adenoma]].
** The specific [[Risk factor|risk factors]] for [[hepatocellular carcinoma]] include [[hepatocellular adenoma]] [[Nodule (medicine)|nodules]] with aberrant [[Cell nucleus|nuclear]] [[Beta-catenin|beta catenin]] [[expression]]. This subgroup seems overpresented in male [[Patient|patients]].
** Male sex and [[tumor]] size >5cm have been identified as [[Risk factor|risk factors]] [[Association (statistics)|associated]] with higher rate of [[malignant transformation]].<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>


==Prognosis==
==== '''[[Bleeding]] and [[Rupture]]''' ====
* The [[prognosis]] is usually good for [[hepatocellular adenoma]].
 
* When [[Diagnosis|diagnosed]], the [[discontinuation]] of [[Oral contraceptive|oral contraception]] or [[androgen]] intake leads to [[regression]] of [[hepatocellular adenoma]].
* Hepatocellular adenoma can be complicated by [[growth]] and [[rupture]].
*[[Bleeding]] in hepatocellular adenoma ranges from small [[subclinical]] [[bleed]] to life threatening [[intraperitoneal]] [[rupture]], resulting in [[hemorrhagic shock]] which requires [[emergency care]].
*[[Bleeding]] and [[rupture]] in hepatocellular adenoma are associated with [[tumor]] size and use of [[Oral contraceptive|oral contraceptives]].
* There is also increased risk of [[rupture]] in [[pregnancy]] because of increased [[hormone]] levels.
* The risk of [[rupture]] does not seem to be associated with [[tumor]] number.
* The risk of [[bleeding]] is directly correlated with size of [[tumor]] and >  5 cm hepatocellular adenomas have a high risk of [[hemorrhage]].
 
==== '''[[Malignant transformation|Malignant Transformation]]''' ====
 
* The [[malignant transformation]] into [[hepatocellular carcinoma]] is a serious but [[rare]] [[Complication (medicine)|complication]] of hepatocellular adenoma.
* The specific [[Risk factor|risk factors]] for [[hepatocellular carcinoma]] include hepatocellular adenoma [[Nodule (medicine)|nodules]] with aberrant [[Cell nucleus|nuclear]] [[beta-catenin]] [[expression]]. This sub-group seems over-presented in male [[Patient|patients]].
* Male sex and [[tumor]] size > 5 cm have been identified as [[Risk factor|risk factors]] [[Association (statistics)|associated]] with higher rate of [[malignant transformation]].<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>
 
===Prognosis===
 
* The [[prognosis]] is usually good for hepatocellular adenoma.
* When [[Diagnosis|diagnosed]], [[discontinuation]] of [[Oral contraceptive|oral contraception]] or [[androgen]] intake leads to [[regression]] of hepatocellular adenoma.
* In cases that do not [[Regression|regress]] after the [[withdrawal]] of [[Oral contraceptive|oral contraception]] or [[androgen]], [[Surgery|surgical treatment]] is the management of choice.<ref>{{Cite journal
* In cases that do not [[Regression|regress]] after the [[withdrawal]] of [[Oral contraceptive|oral contraception]] or [[androgen]], [[Surgery|surgical treatment]] is the management of choice.<ref>{{Cite journal
  | author = [[Sung W. Cho]], [[J. Wallis Marsh]], [[Jennifer Steel]], [[Shane E. Holloway]], [[Jason T. Heckman]], [[Erin R. Ochoa]], [[David A. Geller]] & [[T. Clark Gamblin]]
  | author = [[Sung W. Cho]], [[J. Wallis Marsh]], [[Jennifer Steel]], [[Shane E. Holloway]], [[Jason T. Heckman]], [[Erin R. Ochoa]], [[David A. Geller]] & [[T. Clark Gamblin]]

Latest revision as of 18:48, 20 August 2019

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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]

Overview

If left untreated, hepatocellular adenoma carries 30% bleeding risk.The natural course of hepatocellular adenoma after cessation of oral contraceptive use remains unclear, it may regress or remain stable in size. Complications include bleeding, rupture, and malignant transformation. The prognosis is usually good after discontinuation of oral contraceptives, as it may regress. In cases where it does not regress after oral contraception withdrawal, surgery is the management of choice.

Natural history, Complications, and Prognosis

Natural History

Complications

Bleeding and Rupture

Malignant Transformation

Prognosis

References

  1. ↑ Fauci, Anthony (2008). Harrison's principles of internal medicine. New York: McGraw-Hill Medical. ISBN 978-0071466332.
  2. ↑ C. Bunchorntavakul, R. Bahirwani, D. Drazek, M. C. Soulen, E. S. Siegelman, E. E. Furth, K. Olthoff, A. Shaked & K. R. Reddy (2011). "Clinical features and natural history of hepatocellular adenomas: the impact of obesity". Alimentary pharmacology & therapeutics. 34 (6): 664–674. doi:10.1111/j.1365-2036.2011.04772.x. PMID 21762186. Unknown parameter |month= ignored (help)
  3. ↑ David Q. Wang, Laurie M. Fiske, Caroline T. Carreras & David A. Weinstein (2011). "Natural history of hepatocellular adenoma formation in glycogen storage disease type I". The Journal of pediatrics. 159 (3): 442–446. doi:10.1016/j.jpeds.2011.02.031. PMID 21481415. Unknown parameter |month= ignored (help)
  4. ↑ 4.0 4.1 "Radiopedia 2015 Hepatic adenoma [Dr Matt A. Morgan and Dr Koshy Jacob]".
  5. ↑ 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.
  6. ↑ Jeremiah L. Deneve, Timothy M. Pawlik, Steve Cunningham, Bryan Clary, Srinevas Reddy, Charles R. Scoggins, Robert C. G. Martin, Michael D'Angelica, Charles A. Staley, Michael A. Choti, William R. Jarnagin, Richard D. Schulick & David A. Kooby (2009). "Liver cell adenoma: a multicenter analysis of risk factors for rupture and malignancy". Annals of surgical oncology. 16 (3): 640–648. doi:10.1245/s10434-008-0275-6. PMID 19130136. Unknown parameter |month= ignored (help)
  7. ↑ 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)
  8. ↑ Bunchorntavakul, C.; Bahirwani, R.; Drazek, D.; Soulen, M. C.; Siegelman, E. S.; Furth, E. E.; Olthoff, K.; Shaked, A.; Reddy, K. R. (2011). "Clinical features and natural history of hepatocellular adenomas: the impact of obesity". Alimentary Pharmacology & Therapeutics. 34 (6): 664–674. doi:10.1111/j.1365-2036.2011.04772.x. ISSN 0269-2813.
  9. ↑ Sung W. Cho, J. Wallis Marsh, Jennifer Steel, Shane E. Holloway, Jason T. Heckman, Erin R. Ochoa, David A. Geller & T. Clark Gamblin (2008). "Surgical management of hepatocellular adenoma: take it or leave it?". Annals of surgical oncology. 15 (10): 2795–2803. doi:10.1245/s10434-008-0090-0. PMID 18696154. Unknown parameter |month= ignored (help)


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