Hepatocellular adenoma
| Hepatocellular adenoma | |
|---|---|
| Classification and external resources | |
 Micrograph of a hepatic adenoma (bottom of image). H&E stain. |
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| ICD-O: | M8170/0 |
| DiseasesDB | 5726 |
| eMedicine | med/48 |
| MeSH | D018248 |
Hepatocellular adenoma, also hepatic adenoma, or rarely hepadenoma, is an uncommon benign liver tumor which is associated with the use of hormonal contraception with a high estrogen content.[1] Patients taking higher potency hormones, patients of advanced age, or patients with prolonged duration of use have a significantly increased risk of developing hepatocellular adenomas.[2]
Contents |
[edit] Diagnosis
MRI is the most useful investigation in the diagnosis and work-up.[3] CT may also be used to diagnose hepatic adenomas.
Large hepatic adenomas have a tendency to rupture and bleed massively inside the abdomen.
[edit] Radiologic differential diagnosis
[edit] Pathologic diagnosis
Hepatic adenoma are, typically, well-circumscribed nodules that consist of sheets of hepatocytes with a bubbly vacuolated cytoplasm. The hepatocytes are on a regular reticulin scaffold and less or equal to three cell thick.
The histologic diagnosis of hepatic adenomas can be aided by reticulin staining. In hepatic adenomas, the reticulin scaffold is preserved and hepatocytes do not form layers of four or more hepatocytes, as is seen in hepatocellular carcinoma.
Cells resemble normal hepatocytes and are traversed by blood vessels but lack portal tracts or central veins.
[edit] Etiology
Ninety percent of hepatic adenomas arise in women aged 20–40, most of whom use oral contraceptives.
[edit] Related Conditions
Hepatic adenomas are related to glycogen storage diseases, type 1, as well as anabolic steroids.
[edit] Treatment
Some authors feel that all hepatocellular adenoma should be resected, because of the risk of rupture causing bleeding and because they may contain malignant foci.[4]. Current recommendations are that all hepatic adenomas should be resected, as long as they are surgically accessible and the patient is a reasonable operative candidate. [5] Patients with adenomas should avoid oral contraceptives or hormonal replacement therapy.
[edit] Additional images
[edit] References
- ^ Rooks J, Ory H, Ishak K, Strauss L, Greenspan J, Hill A, Tyler C (1979). "Epidemiology of hepatocellular adenoma. The role of oral contraceptive use.". JAMA 242 (7): 644–8. doi:10.1001/jama.242.7.644. PMID 221698.
- ^ "Hepatocellular Adenoma: eMedicine Gastroenterology". http://emedicine.medscape.com/article/170205-overview.
- ^ Hussain S, van den Bos I, Dwarkasing R, Kuiper J, den Hollander J (2006). "Hepatocellular adenoma: findings at state-of-the-art magnetic resonance imaging, ultrasound, computed tomography and pathologic analysis.". Eur Radiol 16 (9): 1873–86. doi:10.1007/s00330-006-0292-4. PMID 16708218.
- ^ Toso C, Majno P, Andres A, Rubbia-Brandt L, Berney T, Buhler L, Morel P, Mentha G (2005). "Management of hepatocellular adenoma: solitary-uncomplicated, multiple and ruptured tumors.". World J Gastroenterol 11 (36): 5691–5. PMID 16237767.Full text
- ^ Cho, S; Marsh J, Steel J, et al (2008). "Surgical management of hepatocellular adenoma: take it or leave it?". Ann Surg Oncol (15): 2795-2803.
[edit] External links
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