Hepatocellular adenoma natural history, complications and prognosis: Difference between revisions
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==== '''[[Bleeding]] and [[Rupture]]''' ==== | ==== '''[[Bleeding]] and [[Rupture]]''' ==== | ||
* 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]]''' ==== | ==== '''[[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=== | ===Prognosis=== | ||
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
- If left untreated, hepatocellular adenoma carries 30% bleeding risk.[1]
- The natural course of hepatocellular adenoma after cessation of oral contraceptive use remains unclear, it may regress or remain stable in size.[2]
- Obesity and metabolic syndrome may facilitate the progression of hepatocellular adenoma, therefore weight loss may help in stability or regression of the lesion.[3]
Complications
Bleeding and Rupture
- 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 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
- The malignant transformation into hepatocellular carcinoma is a serious but rare complication of hepatocellular adenoma.
- The specific risk factors for hepatocellular carcinoma include hepatocellular adenoma nodules with aberrant nuclear beta-catenin expression. This sub-group seems over-presented in male patients.
- Male sex and tumor size > 5 cm have been identified as risk factors associated with higher rate of malignant transformation.[4]
Prognosis
- The prognosis is usually good for hepatocellular adenoma.
- When diagnosed, 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.[9]
References
- ↑ Fauci, Anthony (2008). Harrison's principles of internal medicine. New York: McGraw-Hill Medical. ISBN 978-0071466332.
- ↑ 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) - ↑ 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) - ↑ 4.0 4.1 "Radiopedia 2015 Hepatic adenoma [Dr Matt A. Morgan and Dr Koshy Jacob]".
- ↑ 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.
- ↑ 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) - ↑ 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) - ↑ 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.
- ↑ 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)