May regress after withdrawal of oral contraceptives
•
Associated with obesity or ethanol use
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
•
Cords or sheets of benign hepatocytes with uniform nuclei
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
Gross Appearance
This large hepatic adenoma 
is well demarcated and tan-brown with streaks of hemorrhage.
Hepatic Adenomatosis
This case of hepatic adenomatosis features multiple adenomas with hemorrhage and necrosis. 
Gross Appearance
Areas of necrosis and hemorrhage are common in hepatic adenoma. 
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
> 10 individual adenomas in 1 liver
Associated with
–
Glycogenosis type Ia or III
ETIOLOGY/PATHOGENESIS
Definite Mechanism Unclear
•
Sex hormones appear to play role
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
Reproductive age in women
•
Sex
Typically women
Presentation
•
Liver mass
Arising in noncirrhotic liver without underlying liver disease
May be multiple
•
Symptoms
Abdominal pain
–
Acute, intermittent, or chronic
•
May be asymptomatic; found on imaging (20% of cases)
•
Associated clinical conditions
Oral contraceptive use
–
May regress after withdrawal of oral contraceptives
Obesity
Metabolic syndrome
Excessive alcohol use
Anabolic steroid use
Tobacco use
Glycogen storage disease
Maturity-onset diabetes of young (MODY) type 3
Laboratory Tests
•
Serum liver tests usually normal including α-fetoprotein
Treatment
•
Stop oral contraceptives
If tumors exceeds 5 cm
If growing in fear of
–
Malignant transformation
•
Liver transplantation in some cases (multiple, etc.)
Prognosis
•
Complete surgical resection should be curative
•
Rarely, malignant transformation (4-10%), bleeding, or rupture
Prevalence of malignancy 10x higher in affected men compared to female counterpart
Only gold members can continue reading.
Log In or
Register to continue
Like this:
Like Loading...
Related
Stay updated, free articles. Join our Telegram channel
