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| | '''For patient information, click [[Hepatocellular adenoma (patient information)|here]]''' |
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| {{Infobox_Disease | | | {{Infobox_Disease | |
| Name = {{PAGENAME}} | | | Name = {{PAGENAME}} | |
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| OMIM = | | | OMIM = | |
| MedlinePlus = | | | MedlinePlus = | |
| eMedicineSubj = med | | | eMedicineSubj = | |
| eMedicineTopic = 48 | | | eMedicineTopic = | |
| MeshID = D018248 | | | MeshID = D018248 | |
| }} | | }} |
| {{SI}} | | {{Hepatocellular adenoma}} |
| {{CMG}} | | {{CMG}}; {{AOEIC}} [[User:zorkun|Cafer Zorkun, M.D., PhD.]] |
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| '''Contributors:''' [[User:zorkun|Cafer Zorkun]] M.D., PhD.
| | ==[[Hepatocellular adenoma overview|Overview]]== |
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| | ==[[Hepatocellular adenoma classification|Classification]]== |
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| ==Overview== | | ==[[Hepatocellular adenoma historical perspective|Historical Perspective]]== |
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| '''Hepatocellular adenoma''', also '''hepatic adenoma''', or rarely '''hepadenoma''', is an uncommon benign [[liver]] tumour which is associated with the use of types 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 pathophysiology|Pathophysiology]]== |
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| ==Diagnosis== | | ==[[Hepatocellular adenoma epidemiology and demographics|Epidemiology & Demographics]]== |
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| [[MRI]] is the most useful investigation in the diagnosis and workup.<ref>{{cite journal | author = Hussain S, van den Bos I, Dwarkasing R, Kuiper J, den Hollander J | title = Hepatocellular adenoma: findings at state-of-the-art magnetic resonance imaging, ultrasound, computed tomography and pathologic analysis. | journal = Eur Radiol | volume = 16 | issue = 9 | pages = 1873-86 | year = 2006 | id = PMID 16708218}}</ref> | | ==[[Hepatocellular adenoma epidemiology and demographics|Risk Factors]]== |
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| ==Diagnostic Findings== | | ==[[Hepatocellular adenoma screening|Screening]]== |
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| ===Ultrasonography=== | | ==[[Hepatocellular adenoma causes|Causes]]== |
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| * Color Doppler US may demonstrate peripheral peritumoral vessels and intratumoral vessels that typically have a flat continuous or, less commonly, triphasic waveform. *These Doppler US features are reported to be absent in the vessels within focal nodular hyperplasia and may be useful in distinguishing the two disease entities. *Nevertheless, most adenomas are not specifically diagnosed at US and are usually further evaluated with CT or other imaging modalities.
| | ==[[Hepatocellular adenoma differential diagnosis|Differentiating Hepatocellular adenoma from other Diseases]]== |
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| ===Computed Tomography=== | | ==[[Hepatocellular adenoma natural history|Natural History, Complications & Prognosis]]== |
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| * Fat or hemorrhage can easily be identified on unenhanced images, and delayed-phase images demonstrate the tendency for fibrotic components to enhance and retain contrast material.
| | ==Diagnosis== |
| | | [[Hepatocellular adenoma history and symptoms|History & Symptoms]] | [[Hepatocellular adenoma physical examination|Physical Examination]] | [[Hepatocellular adenoma staging|Staging]] | [[Hepatocellular adenoma laboratory tests|Lab Tests]] | [[Hepatocellular adenoma electrocardiogram|Electrocardiogram]] | [[Hepatocellular adenoma chest x ray|Chest X Ray]] | [[Hepatocellular adenoma CT|CT]] | [[Hepatocellular adenoma MRI|MRI]] | [[Hepatocellular adenoma echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Hepatocellular adenoma other imaging findings#Nuclear Scintigraphy|Nuclear Scintigraphy]] | [[Hepatocellular adenoma other diagnostic studies|Other Diagnostic Studies]] |
| * Because adenomas consist almost entirely of uniform hepatocytes and a variable number of Kupffer cells, most adenomas are nearly isoattenuating relative to normal liver on unenhanced, portal venous–phase, and delayed-phase images.
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| * In patients with fatty liver, adenomas are hyperattenuating at all phases of contrast enhancement and on unenhanced images as well.
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| * Small hepatocellular adenomas enhance rapidly and are hyperattenuating relative to the liver.
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| * Excluding lesions with acute or old tumor hemorrhage and fat deposition, hepatocellular adenoma demonstrated homogeneous or nearly homogeneous enhancement in approx 80% of cases.
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| ** The enhancement usually does not persist in adenomas because of arteriovenous shunting.
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| * Larger hepatocellular adenomas may be more heterogeneous than smaller lesions, and their CT appearance is less specific.
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| ===Magnetic Resonance Imaging=== | |
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| * On T1-weighted MR images, hepatocellular adenomas have been variously described as hyperintense, isointense, and hypointense lesions.
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| * It has been reported that 47%–74% of hepatocellular adenomas are predominantly hyperintense relative to liver on T2-weighted images; this is due to prolonged T2 and is consistent with findings in other hepatic tumors.
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| * Some lesions are hypointense and isointense on T2-weighted images.
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| * Most lesions are heterogeneous, demonstrating a combination of hyper- and hypointensity on T2-weighted images relative to hemorrhage and necrosis.
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| *Dynamic gadolinium-enhanced gradient-echo MR imaging, like dynamic CT, can be used to demonstrate early arterial enhancement that reflects the presence of subcapsular feeding vessels.
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| *Adenomas usually do not show uptake of superparamagnetic iron oxide particles, resulting in decreased signal intensity on T2-weighted images.
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| *After injection of a hepatocellular-specific contrast agent such as gadolinium benzyloxypropionictetraacetate (Gd-BOPTA) there is usually no substantial uptake.
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| ===Nuclear Scintigraphy===
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| * Compared with normal liver, adenomas usually show absent or decreased uptake of Tc-99m sulfur colloid, reflecting the decreased number or function of Kupffer cells.
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| [http://www.radswiki.net Images courtesy of RadsWiki] | |
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| <gallery perRow="3">
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| Image:Hepatic ademona CT 001.jpg|CT portal venous phase: A patient with multiple adenoma
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| Image:Hepatic ademona CT 002.jpg|CT portal venous phase: A patient with multiple adenoma
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| Image:Hepatic ademona MRI 003.jpg|T2 SSFSE: A patient with multiple adenoma
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| Image:Hepatic ademona MRI 004.jpg|T2 SSFSE: A patient with multiple adenoma
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| Image:Hepatic ademona MRI 005.jpg|T2 Fat sat: A patient with multiple adenoma
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| Image:Hepatic ademona MRI 006.jpg|In phase: A patient with multiple adenoma
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| Image:Hepatic ademona MRI 007.jpg|Out of phase: A patient with multiple adenoma
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| Image:Hepatic ademona MRI 008.jpg|T1 fat sat: A patient with multiple adenoma
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| Image:Hepatic ademona MRI 009.jpg|T1 fat sat arterial: A patient with multiple adenoma
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| Image:Hepatic ademona MRI 010.jpg|T1 fat sat arterial: A patient with multiple adenoma
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| Image:Hepatic ademona MRI 011.jpg|T1 fat sat delayed: A patient with multiple adenoma
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| Image:Hepatic ademona MRI 012.jpg|T1 fat sat delayed: A patient with multiple adenoma
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| </gallery>
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| ==Treatment== | | ==Treatment== |
| | | [[Hepatocellular adenoma medical therapy|Medical Therapy]] | [[Hepatocellular adenoma surgery|Surgery]] | [[Hepatocellular adenoma primary prevention|Primary Prevention]] | [[Hepatocellular adenoma secondary prevention|Secondary Prevention]] |
| All hepatocellular adenoma should be surgically resected, because of the risk of rupture causing bleeding and because they may contain malignant foci.<ref>{{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>
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| ==References==
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| {{reflist|2}}
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| {{Epithelial neoplasms}} | | {{Epithelial neoplasms}} |
| {{SIB}} | | {{SIB}} |
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| | [[Category:Disease]] |
| | [[Category:Types of cancer]] |
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| | [[Category:Oncology]] |
| | [[Category:Gastroenterology]] |
| [[Category:Hepatology]] | | [[Category:Hepatology]] |
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| [[Category:Hematology]] | | [[Category:Hematology]] |
| [[Category:Oncology]]
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