Hepatocellular adenoma natural history

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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]

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;
• 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.

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

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