Hepatic Adenoma
Matthew M. Yeh, MD, PhD
Key Facts
Etiology/Pathogenesis
Almost always associated with oral contraceptive or long-term steroid use
May regress after withdrawal of oral contraceptives
Clinical Issues
Typically in women of reproductive age
Noncirrhotic background liver
Symptoms
Abdominal pain; acute, intermittent, or chronic
Complications
Bleeding
Rupture; pregnancy is risk factor
Slight chance of malignant transformation
Microscopic Pathology
Cords or sheets of benign hepatocytes with uniform nuclei
Low nuclear to 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
Hepatocellular carcinoma
Focal nodular hyperplasia
Nodular regenerative hyperplasia
 This partial hepatectomy specimen shows a well-circumscribed yellow-tan adenoma under the capsule, in a background of noncirrhotic liver. |
 This low-power photomicrograph of hepatic adenoma shows sheets of benign tumor cells with numerous thin-walled unpaired vessels. |
TERMINOLOGY
Definitions
Benign liver neoplasm composed of cells of hepatocytic origin
ETIOLOGY/PATHOGENESIS
Definite Mechanism Unclear
Sex hormones appear to play a role
Almost always associated with oral contraceptive or long-term steroid use
Also associated with glycogen storage disease types I and III, galactosemia, tyrosinemia
CLINICAL ISSUES
Epidemiology
Age
Reproductive age
Gender
Typically in women
Presentation
Liver mass
Arising in noncirrhotic liver
Often without underlying liver disease
Associated with oral contraceptive use
May regress after withdrawal of oral contraceptives
Symptoms
Abdominal pain
Acute, intermittent, or chronic
May be asymptomatic; found on imaging (20% of cases)
Laboratory Tests
Serum liver tests usually normal
α-fetoprotein normal
Treatment
Stop oral contraceptives
Embolization
Surgical resection
Often favored considering risks of bleeding, rupture, and malignant transformation
Liver transplantation in unresectable cases
Prognosis
Surgical resection may be indicated if lesion is symptomatic or increases in size
Complete surgical resection should be curative
Complications
Bleeding
Rupture
Pregnancy is risk factor for rupture
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