Hepatocellular adenoma natural history: Difference between revisions
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==Overview== | ==Overview== | ||
There is 30% bleeding risk for hepatocellular adenoma if left untreated. 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. | There is 30% [[bleeding]] risk for [[hepatocellular adenoma]] if left untreated. The natural course of [[hepatocellular adenoma]] after cessation of [[Oral contraceptive|oral contraceptive use]] remains unclear, it may [[Regression|regress]] or remain stable in size. [[Complication (medicine)|Complications]] include [[bleeding]], [[rupture]] and [[malignant transformation]]. The [[prognosis]] is usually good after discontinuation of [[Oral contraceptive|oral contraceptives]], as it may [[Regression|regress]]. In cases where it does not [[Regression|regress]] after [[Oral contraceptive|oral contraception]] [[withdrawal]], [[surgery]] is the management of choice. | ||
==Natural history== | ==Natural history== | ||
* The hepatocellular adenoma if left untreated, there is 30% bleeding risk.<ref>{{cite book | last = Fauci | first = Anthony | title = Harrison's principles of internal medicine | publisher = McGraw-Hill Medical | location = New York | year = 2008 | isbn = 978-0071466332 }}</ref> | * The [[hepatocellular adenoma]] if left untreated, there is 30% [[bleeding]] risk.<ref>{{cite book | last = Fauci | first = Anthony | title = Harrison's principles of internal medicine | publisher = McGraw-Hill Medical | location = New York | year = 2008 | isbn = 978-0071466332 }}</ref> | ||
* The natural course of hepatocellular adenoma after cessation of oral contraceptive use remains unclear, it may regress or remain stable in size.<ref>{{Cite journal | * The natural course of [[hepatocellular adenoma]] after cessation of [[Oral contraceptive|oral contraceptive use]] remains unclear, it may [[Regression|regress]] or remain stable in size.<ref>{{Cite journal | ||
| author = [[C. Bunchorntavakul]], [[R. Bahirwani]], [[D. Drazek]], [[M. C. Soulen]], [[E. S. Siegelman]], [[E. E. Furth]], [[K. Olthoff]], [[A. Shaked]] & [[K. R. Reddy]] | | author = [[C. Bunchorntavakul]], [[R. Bahirwani]], [[D. Drazek]], [[M. C. Soulen]], [[E. S. Siegelman]], [[E. E. Furth]], [[K. Olthoff]], [[A. Shaked]] & [[K. R. Reddy]] | ||
| title = Clinical features and natural history of hepatocellular adenomas: the impact of obesity | | title = Clinical features and natural history of hepatocellular adenomas: the impact of obesity | ||
| Line 21: | Line 21: | ||
| pmid = 21762186 | | pmid = 21762186 | ||
}}</ref> | }}</ref> | ||
* Obesity and metabolic syndrome may facilitate the progression of hepatocellular adenoma, therefore weight loss may help in stability or regression of the lesion.<ref>{{Cite journal | * [[Obesity]] and [[metabolic syndrome]] may facilitate the progression of [[hepatocellular adenoma]], therefore [[weight loss]] may help in stability or [[regression]] of the [[lesion]].<ref>{{Cite journal | ||
| author = [[David Q. Wang]], [[Laurie M. Fiske]], [[Caroline T. Carreras]] & [[David A. Weinstein]] | | author = [[David Q. Wang]], [[Laurie M. Fiske]], [[Caroline T. Carreras]] & [[David A. Weinstein]] | ||
| title = Natural history of hepatocellular adenoma formation in glycogen storage disease type I | | title = Natural history of hepatocellular adenoma formation in glycogen storage disease type I | ||
| Line 35: | Line 35: | ||
==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><ref>{{Cite journal | * The [[Complication (medicine)|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><ref>{{Cite journal | ||
| author = [[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]] | | author = [[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]] | ||
| title = Liver cell adenoma: a multicenter analysis of risk factors for rupture and malignancy | | title = Liver cell adenoma: a multicenter analysis of risk factors for rupture and malignancy | ||
| Line 58: | Line 58: | ||
| pmid = 27803743 | | pmid = 27803743 | ||
}}</ref><ref name="BunchorntavakulBahirwani2011">{{cite journal|last1=Bunchorntavakul|first1=C.|last2=Bahirwani|first2=R.|last3=Drazek|first3=D.|last4=Soulen|first4=M. C.|last5=Siegelman|first5=E. S.|last6=Furth|first6=E. E.|last7=Olthoff|first7=K.|last8=Shaked|first8=A.|last9=Reddy|first9=K. R.|title=Clinical features and natural history of hepatocellular adenomas: the impact of obesity|journal=Alimentary Pharmacology & Therapeutics|volume=34|issue=6|year=2011|pages=664–674|issn=02692813|doi=10.1111/j.1365-2036.2011.04772.x}}</ref> | }}</ref><ref name="BunchorntavakulBahirwani2011">{{cite journal|last1=Bunchorntavakul|first1=C.|last2=Bahirwani|first2=R.|last3=Drazek|first3=D.|last4=Soulen|first4=M. C.|last5=Siegelman|first5=E. S.|last6=Furth|first6=E. E.|last7=Olthoff|first7=K.|last8=Shaked|first8=A.|last9=Reddy|first9=K. R.|title=Clinical features and natural history of hepatocellular adenomas: the impact of obesity|journal=Alimentary Pharmacology & Therapeutics|volume=34|issue=6|year=2011|pages=664–674|issn=02692813|doi=10.1111/j.1365-2036.2011.04772.x}}</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]]. | ||
** Bleeding and rupture in hepatocellular adenoma are associated with tumor size and use of oral contraceptives. | ** [[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. | ** 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 [[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 adenoma|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 (medicine)|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 factor|risk factors]] for [[hepatocellular carcinoma]] include [[hepatocellular adenoma]] [[Nodule (medicine)|nodules]] with aberrant [[Cell nucleus|nuclear]] [[Beta-catenin|beta catenin]] [[expression]]. This subgroup seems overpresented in male [[Patient|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 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== | ||
* The prognosis is usually good for hepatocellular adenoma. | * The [[prognosis]] is usually good for [[hepatocellular adenoma]]. | ||
* When diagnosed, the discontinuation of oral contraception or androgen intake leads to regression of hepatocellular adenoma. | * When [[Diagnosis|diagnosed]], the [[discontinuation]] of [[Oral contraceptive|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.<ref>{{Cite journal | * In cases that do not [[Regression|regress]] after the [[withdrawal]] of [[Oral contraceptive|oral contraception]] or [[androgen]], [[Surgery|surgical treatment]] is the management of choice.<ref>{{Cite journal | ||
| author = [[Sung W. Cho]], [[J. Wallis Marsh]], [[Jennifer Steel]], [[Shane E. Holloway]], [[Jason T. Heckman]], [[Erin R. Ochoa]], [[David A. Geller]] & [[T. Clark Gamblin]] | | author = [[Sung W. Cho]], [[J. Wallis Marsh]], [[Jennifer Steel]], [[Shane E. Holloway]], [[Jason T. Heckman]], [[Erin R. Ochoa]], [[David A. Geller]] & [[T. Clark Gamblin]] | ||
| title = Surgical management of hepatocellular adenoma: take it or leave it? | | title = Surgical management of hepatocellular adenoma: take it or leave it? | ||
Latest revision as of 15:21, 15 January 2019
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Hepatocellular adenoma natural history On the Web |
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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
There is 30% bleeding risk for hepatocellular adenoma if left untreated. 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
- The hepatocellular adenoma if left untreated, there is 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
- The complications of hepatocellular adenoma include;[4][5][6][7][8]
- 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 of malignant transformation.[4]
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.[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)