Hepatic Adenoma

 May regress after withdrawal of oral contraceptives



• Associated with obesity or ethanol use




Clinical Issues




• Typically in women of reproductive age
image Noncirrhotic background liver

• Symptoms
image Abdominal pain; acute, intermittent, or chronic

• Complications
image Bleeding

image Rupture; pregnancy is risk factor

image Slight chance of malignant transformation


Microscopic




• Cords or sheets of benign hepatocytes with uniform nuclei
image Low nuclear:cytoplasmic ratio

• Portal structures lacking

• Numerous unpaired arteries

• Intact reticulin framework

• Hemorrhage &/or infarcts may be present with hemosiderin-laden macrophages or fibrotic regions


Top Differential Diagnoses




• Well-differentiated hepatocellular carcinoma

• Focal nodular hyperplasia

• Nodular regenerative hyperplasia

image
Gross Appearance
This large hepatic adenoma image is well demarcated and tan-brown with streaks of hemorrhage.


image
Hepatic Adenomatosis
This case of hepatic adenomatosis features multiple adenomas with hemorrhage and necrosis.

image
Gross Appearance
Areas of necrosis and hemorrhage are common in hepatic adenoma.

image
Sheets of Hepatocytes
Low-magnification view shows sheets of hepatocytes with numerous thin-walled vessels in hepatic adenoma.


TERMINOLOGY


Definitions




• Benign liver neoplasm composed of cells of hepatocytic origin
• Adenomatosis

image > 10 individual adenomas in 1 liver

image Associated with

– Glycogenosis type Ia or III

– Klinefelter syndrome

– Familial adenomatosis


ETIOLOGY/PATHOGENESIS


Definite Mechanism Unclear




• Sex hormones appear to play role
image Commonly associated with oral contraceptive or long-term steroid use

– Newer generation contraceptive pills with lower estrogen content may be associated with lower risk

• Also associated with obesity and ethanol use

• Also associated with glycogen storage disease types I and III, galactosemia, tyrosinemia


CLINICAL ISSUES


Epidemiology




• Age
image Reproductive age in women

• Sex
image Typically women


Presentation




• Liver mass
image Arising in noncirrhotic liver without underlying liver disease

image May be multiple

• Symptoms
image Abdominal pain
– Acute, intermittent, or chronic

• May be asymptomatic; found on imaging (20% of cases)

• Associated clinical conditions
image Oral contraceptive use
– May regress after withdrawal of oral contraceptives

image Obesity

image Metabolic syndrome

image Excessive alcohol use

image Anabolic steroid use

image Tobacco use

image Glycogen storage disease

image Maturity-onset diabetes of young (MODY) type 3


Laboratory Tests




• Serum liver tests usually normal including α-fetoprotein


Treatment




• Stop oral contraceptives
• Locoregional therapies

• Surgical resection

image If tumors exceeds 5 cm

image If growing in fear of

– Bleeding

– Rupture

– Malignant transformation

• Liver transplantation in some cases (multiple, etc.)


Prognosis




• Complete surgical resection should be curative
• Rarely, malignant transformation (4-10%), bleeding, or rupture

image Prevalence of malignancy 10x higher in affected men compared to female counterpart

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Apr 20, 2017 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Hepatic Adenoma
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