Hepatocellular adenoma natural history: Difference between revisions
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==Complications== | ==Complications== | ||
* The 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> | * The 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> | ||
* Bleeding and rupture | * '''Bleeding and rupture''' | ||
** The presence of hepatocellular adenoma can be complicated by growth 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 in hepatocellular adenoma ranges from small subclinical bleed to life threatening intraperitoneal rupture, resulting in hemorrhagic shock requiring emergency care. | ||
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** The risk of rupture does not seem to be associated with tumor number. | ** 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 adenomas have a high risk of hemorrhage. | ** The risk of bleeding is directly correlated with size of tumor and > 5cm hepatocellular adenomas have a high risk of hemorrhage. | ||
* Malignant transformation | * '''Malignant transformation''' | ||
** The malignant transformation into hepatocellular carcinoma is a serious but rare complication of hepatocellular adenoma. | ** 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 subgroup seems overpresented in male patients. | ** The specific risk factors for hepatocellular carcinoma include hepatocellular adenoma nodules with aberrant nuclear beta catenin expression. This subgroup seems overpresented in male patients. | ||
** Male sex and tumor size >5cm have been identified as risk factors associated with higher rate 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> | ** Male sex and tumor size >5cm have been identified as risk factors associated with higher rate 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== | ||
* The prognosis is usually good for hepatocellular adenoma. | * The prognosis is usually good for hepatocellular adenoma. | ||
Revision as of 17:21, 3 January 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
Natural history
- The hepatocellular adenoma if left untreated, there is 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.
- Obesity and metabolic syndrome may facilitate the progression of hepatocellular adenoma, therefore weight loss may help in stability or regression of the lesion.
Complications
- The complications of hepatocellular adenoma include;[1][2]
- 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 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 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 subgroup seems overpresented in male patients.
- Male sex and tumor size >5cm have been identified as risk factors associated with higher rate malignant transformation.[1]
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.
References
- ↑ 1.0 1.1 "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.