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Ben Abderrahim S, Chérif K, Nfikha Z, Gharsallaoui S, El Aini I, Jedidi M, Mokni M, Ben Dhiab M. Fatal rupture of hepatic adenomatosis: Autopsy case and review of the literature. J Forensic Sci 2023. [PMID: 37144741 DOI: 10.1111/1556-4029.15272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/13/2023] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
Hepatic adenomatosis is a rare disease consisting of multiple adenomas in otherwise-normal liver parenchyma. Though the discovery of this entity goes back several years, its diagnosis is still challenging in terms of its definition and pathophysiology. Clinically, patients may be completely asymptomatic and the diagnosis is only made incidentally through imaging tests. The discovery could be made when complications occur such as intraperitoneal hemorrhage with hypovolemic shock due to the rupture of an adenoma. We report a fatal case of a ruptured adenoma in a case of hepatic adenomatosis discovered at autopsy. In order to achieve a better view of this disease, we conducted a literature review on this subject describing the pathogenesis, manifestations, and autopsy contribution to addressing this entity.
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Affiliation(s)
- Sarra Ben Abderrahim
- Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia
- Department of Forensic Medicine, Ibn El Jazzar University Hospital, Kairouan, Tunisia
| | - Khouloud Chérif
- Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia
- Department of Forensic Medicine, Farhat Hached University Hospital, Sousse, Tunisia
| | - Zeineb Nfikha
- Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia
- Department of Pathological Anatomy and Cytology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Sarra Gharsallaoui
- Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia
- Department of Forensic Medicine, Farhat Hached University Hospital, Sousse, Tunisia
| | - Imen El Aini
- Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia
- Department of Forensic Medicine, Farhat Hached University Hospital, Sousse, Tunisia
| | - Maher Jedidi
- Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia
- Department of Forensic Medicine, Farhat Hached University Hospital, Sousse, Tunisia
| | - Moncef Mokni
- Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia
- Department of Pathological Anatomy and Cytology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Mohamed Ben Dhiab
- Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia
- Department of Forensic Medicine, Farhat Hached University Hospital, Sousse, Tunisia
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2
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Doi Y, Kim SH, Ishigaki M, Sato K, Yoshimoto J, Mitsushita N, Nii M, Yamoto M, Urushihara N, Tanaka Y. Angiographic diagnosis for accurate assessment of congenital porto-systemic shunt and extrahepatic portal vein obstruction in children. Pediatr Int 2022; 64:e14856. [PMID: 34048141 DOI: 10.1111/ped.14856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 04/16/2021] [Accepted: 05/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Congenital porto-systemic shunt (CPSS) is a rare disease and can cause fatal complications. Accurate angiographic assessment is mandatory for proper treatment. Although technically difficult, we developed assessment techniques and assessed their accuracy. One technique came from evaluating patients with extrahepatic portal vein obstruction (EHPVO). METHODS We conducted a single center retrospective study to evaluate the efficacy of angiographic diagnostic procedure for the assessment of CPSS and EHPVO, and its impact on patients' subsequent interventions and clinical course. Eight patients with CPSS and two patients with EHPVO who underwent diagnostic angiography were included. Assessment of the intrahepatic portal vein was performed in all patients. The route of the shunt, and portal vein pressure under shunt occlusion, were also evaluated for patients with CPSS. Evaluation was first attempted with a balloon angiographic catheter (standard method). Three additional techniques were performed as needed: (i) direct wedge-catheter injection without balloon inflation, (ii) use of occlusion balloon in two patients, and (iii) hybrid angiography with sheath placement directly into the superior mesenteric vein. RESULTS The standard method was sufficient in four patients. On the other hand, all three techniques were required in two patients each. One lost contact during follow up, but all other patients underwent optimal intervention. There were no complications related to the angiographic procedure. CONCLUSIONS Use of direct wedge-catheter injection without balloon inflation, occlusion balloon, and hybrid catheterization improved the diagnostic yield in patients with CPSS or EHPVO.
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Affiliation(s)
- Yuji Doi
- Department of Cardiology, Shizuoka Children's Hospital, Shizuoka-City, Shizuoka, Japan
| | - Sung-Hae Kim
- Department of Cardiology, Shizuoka Children's Hospital, Shizuoka-City, Shizuoka, Japan
| | - Mizuhiko Ishigaki
- Department of Cardiology, Shizuoka Children's Hospital, Shizuoka-City, Shizuoka, Japan
| | - Keisuke Sato
- Department of Cardiology, Shizuoka Children's Hospital, Shizuoka-City, Shizuoka, Japan
| | - Jun Yoshimoto
- Department of Cardiology, Shizuoka Children's Hospital, Shizuoka-City, Shizuoka, Japan
| | - Norie Mitsushita
- Department of Cardiology, Shizuoka Children's Hospital, Shizuoka-City, Shizuoka, Japan
| | - Masaki Nii
- Department of Cardiology, Shizuoka Children's Hospital, Shizuoka-City, Shizuoka, Japan
| | - Masaya Yamoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka-City, Shizuoka, Japan
| | - Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka-City, Shizuoka, Japan
| | - Yasuhiko Tanaka
- Department of Cardiology, Shizuoka Children's Hospital, Shizuoka-City, Shizuoka, Japan
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3
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Dauleh H, Soliman A, Haris B, Khalifa A, Al Khori N, Hussain K. Case Report: Hepatic Adenomatosis in a Patient With Prader-Willi Syndrome. Front Endocrinol (Lausanne) 2022; 13:826772. [PMID: 35355562 PMCID: PMC8959895 DOI: 10.3389/fendo.2022.826772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/31/2022] [Indexed: 01/11/2023] Open
Abstract
Prader-Willi syndrome (PWS) is a genetic disorder caused by the lack of expression of genes on the paternally inherited chromosome region 15q11.2-q13. It is a multisystem disorder that is characterized by severe hypotonia with poor suck and feeding difficulties in early infancy, followed in early childhood by excessive eating and gradual development of morbid obesity. The incidence of type 2 diabetes mellitus is high, particularly in obese patients. Non-alcoholic fatty liver disease has also been reported in some patients with PWS. Liver adenomatosis is a benign vascular lesion of the liver, defined by the presence of >10 adenomas, in the otherwise healthy liver parenchyma. We report the first case of a patient with PWS with severe obesity, type 2 diabetes mellitus, and non-alcoholic fatty liver who also developed liver adenomatosis, review the pediatric literature on liver adenomatosis, and discuss the potential underlying mechanisms.
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Affiliation(s)
- Hajar Dauleh
- Department of Pediatric Medicine, Division of Endocrinology, Sidra Medicine, Doha, Qatar
| | - Ali Soliman
- Department of Pediatric Medicine, Division of Endocrinology, Sidra Medicine, Doha, Qatar
| | - Basma Haris
- Department of Pediatric Medicine, Division of Endocrinology, Sidra Medicine, Doha, Qatar
| | - Amal Khalifa
- Department of Pediatric Medicine, Division of Endocrinology, Sidra Medicine, Doha, Qatar
| | - Noor Al Khori
- Department of Pediatric Medicine, Division of Diagnostic Radiology, Sidra Medicine, Doha, Qatar
| | - Khalid Hussain
- Department of Pediatric Medicine, Division of Endocrinology, Sidra Medicine, Doha, Qatar
- *Correspondence: Khalid Hussain, ; www.sidra.org
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4
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Ostojic A, Mrzljak A, Mikulic D. Liver transplantation for benign liver tumors. World J Hepatol 2021; 13:1098-1106. [PMID: 34630877 PMCID: PMC8473500 DOI: 10.4254/wjh.v13.i9.1098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/12/2021] [Accepted: 07/21/2021] [Indexed: 02/06/2023] Open
Abstract
Benign liver tumors are common lesions that are usually asymptomatic and are often found incidentally due to recent advances in imaging techniques and their widespread use. Although most of these tumors can be managed conservatively or treated by surgical resection, liver transplantation (LT) is the only treatment option in selected patients. LT is usually indicated in patients that present with life-threatening complications, when the lesions are diffuse in the hepatic parenchyma or when malignant transformation cannot be ruled out. However, due to the significant postoperative morbidity of the procedure, scarcity of available donor liver grafts, and the benign course of the disease, the indications for LT are still not standardized. Hepatic adenoma and adenomatosis, hepatic hemangioma, and hepatic epithelioid hemangioendothelioma are among the most common benign liver tumors treated by LT. This article reviews the role of LT in patients with benign liver tumors. The indications for LT and long-term outcomes of LT are presented.
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Affiliation(s)
- Ana Ostojic
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb 10000, Croatia
| | - Anna Mrzljak
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb 10000, Croatia
| | - Danko Mikulic
- Department of Surgery, University Hospital Merkur, Zagreb 10000, Croatia
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5
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Mota C, Carvalho AM, Fonseca V, Silva MT, Victorino RMM. Exuberant liver adenomatosis presenting with iron deficiency anemia. Clin Case Rep 2017; 5:574-577. [PMID: 28469852 PMCID: PMC5412824 DOI: 10.1002/ccr3.814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 11/23/2022] Open
Abstract
Intratumoral or intraperitoneal hemorrhage is a recognized complication of liver adenomatosis. We report a case of multifocal massive liver adenomatosis presenting as chronic iron deficiency anemia. Clinicians’ awareness about this atypical presentation not highlighted in the literature is important to allow timely diagnosis and surgical intervention to prevent fatal complications.
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Affiliation(s)
- Catarina Mota
- Clínica Universitária de Medicina II; Centro Hospitalar Lisboa Norte; Lisboa Portugal
| | | | - Válter Fonseca
- Clínica Universitária de Medicina II; Centro Hospitalar Lisboa Norte; Lisboa Portugal
| | - Marisa Teixeira Silva
- Clínica Universitária de Medicina II; Centro Hospitalar Lisboa Norte; Lisboa Portugal
| | - Rui M. M. Victorino
- Clínica Universitária de Medicina II; Centro Hospitalar Lisboa Norte; Lisboa Portugal
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6
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Agrawal S, Agarwal S, Arnason T, Saini S, Belghiti J. Management of Hepatocellular Adenoma: Recent Advances. Clin Gastroenterol Hepatol 2015; 13:1221-30. [PMID: 24909909 DOI: 10.1016/j.cgh.2014.05.023] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/20/2014] [Accepted: 05/20/2014] [Indexed: 02/07/2023]
Abstract
Hepatocellular adenoma (HCA) is a rare benign liver cell neoplasm that occurs more frequently in young women with a history of prolonged use of oral contraceptives. Surgical resection is considered because of the risk of hemorrhage in 25% and of malignant transformation in 5% of patients with HCA. HCA is a heterogeneous disease comprising 3 subtypes with distinct molecular and complication profiles. The inflammatory or telangiectatic subtype is at increased risk for hemorrhage, the β-catenin-activated subtype is at increased risk for malignant transformation, and the hepatocyte nuclear factor-1α-inactivated or steatotic subtype is at the least risk for complications. One-third of the patients with HCA have multiple tumors on imaging with no increased risk of complications. Magnetic resonance imaging is the modality of choice for the diagnosis and subtype characterization of HCA. Systematic resection of HCA is recommended in male patients owing to the higher incidence of malignant transformation, and surgical excision in women should be reserved for tumors 5 cm or larger associated with an increased risk of complications. Cessation of hormonal therapy and radiologic surveillance in women with HCA tumors smaller than 5 cm shows that the vast majority of HCA remain stable or undergo spontaneous regression. Percutaneous core needle biopsy is of limited value because the therapeutic strategy is based primarily on patient sex and tumor size. Transarterial embolization is the initial treatment for HCA complicated by hemorrhage. Pregnancy should not be discouraged in the presence of HCA, however, frequent sonographic surveillance is recommended.
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Affiliation(s)
- Shefali Agrawal
- Hepatobiliary and Pancreatic Surgery, Department of Surgical Oncology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Sheela Agarwal
- Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Thomas Arnason
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sanjay Saini
- Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jacques Belghiti
- Department of Hepatobiliary and Transplant Surgery, Beaujon Hospital, University of Paris, Clichy, France.
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7
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Di Sandro S, Slim AO, Lauterio A, Giacomoni A, Mangoni I, Aseni P, Pirotta V, Aldumour A, Mihaylov P, De Carlis L. Liver adenomatosis: a rare indication for living donor liver transplantation. Transplant Proc 2014; 41:1375-7. [PMID: 19460563 DOI: 10.1016/j.transproceed.2009.03.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Liver adenomatosis (LA) is a rare benign disease of the liver with unclear pathogenesis, which is characterized by multiple hepatic adenomas. The management of LA remains controversial. Herein we have reported a case of LA treated by living donor liver transplantation (LDLT). A 48-year-old woman developed multiple liver adenomas. In view of the sizes and localizations of the lesions, the patient underwent right hepatic resection and segment II nodulectomy. Thirty-four months later, she developed recurrence of multiple hepatic adenomas and 2 nodules were highly suspect for hepatocellular carcinoma. Re-resection was not indicated due to the whole liver being involved with adenomas. The patient underwent LDLT. At 45 months thereafter she is alive and disease-free. In conclusion, LDLT is indicated in cases of nonresectability; it may offer optimal results in view of the absence of portal hypertension and the elimination of waiting list time.
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Affiliation(s)
- S Di Sandro
- Department of Surgery, Niguarda Ca' Granda Hospital, Milan, Italy.
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8
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Belghiti J, Cauchy F, Paradis V, Vilgrain V. Diagnosis and management of solid benign liver lesions. Nat Rev Gastroenterol Hepatol 2014; 11:737-49. [PMID: 25178878 DOI: 10.1038/nrgastro.2014.151] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
More and more asymptomatic benign liver tumours are discovered incidentally and can be divided into regenerative lesions and true neoplastic lesions. The most common regenerative lesions include hemangioma, focal nodular hyperplasia and inflammatory pseudotumours of the liver. Neoplastic lesions include hepatocellular adenomas and angiomyolipomas. Regenerative lesions rarely increase in volume, do not yield a higher risk of complications and usually do not require treatment. By contrast, hepatocellular adenomas and angiomyolipomas can increase in volume and are associated with a risk of complications. Large hepatocellular adenomas (>5 cm in diameter) are undoubtedly associated with a risk of bleeding and malignant transformation, particularly the inflammatory (also known as telangiectatic) and β-catenin mutated subtypes. Accurate diagnosis needs to be obtained to select patients eligible for surgical resection. MRI has markedly improved diagnosis and can identify the major hepatocellular adenomas subtypes. The use of biopsy results to inform the indication for resection remains questionable. However, when diagnosis remains uncertain after imaging, percutaneous biopsy could help improve diagnostic accuracy.
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Affiliation(s)
- Jacques Belghiti
- Department of Hepatobiliary Surgery and Liver Transplantation, Beaujon Hospital, University Paris-Diderot, 100 Boulevard du General Leclerc, 92110 Clichy, France
| | - François Cauchy
- Department of Hepatobiliary Surgery and Liver Transplantation, Beaujon Hospital, University Paris-Diderot, 100 Boulevard du General Leclerc, 92110 Clichy, France
| | - Valérie Paradis
- Department of Pathology, Beaujon Hospital, University Paris-Diderot, 100 Boulevard du General Leclerc, 92110 Clichy, France
| | - Valérie Vilgrain
- Department of Radiology, Beaujon Hospital, University Paris-Diderot, 100 Boulevard du General Leclerc, 92110 Clichy, France
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9
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Dokmak S, Cauchy F, Belghiti J. Resection, transplantation and local regional therapies for liver adenomas. Expert Rev Gastroenterol Hepatol 2014; 8:803-10. [PMID: 24957321 DOI: 10.1586/17474124.2014.917957] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Hepatocellular adenoma (HCA) is a rare benign liver-cell neoplasm, occurring predominantly in young obese women using oral contraceptives. HCA is a heterogeneous disease, which includes four subtypes (including unclassified) associated with various risks of haemorrhagic complications and malignant transformation. Magnetic resonance imaging is the modality of choice for both diagnosis and subtype characterization of HCA whereas percutaneous biopsy has only limited impact on the therapeutic strategy. In men HCA should be always resected while in women surgery should only be considered for lesions ≥5 cm and after cessation of hormonal therapy. Women with single or multiple HCAs <5 cm may be followed with regular MRI imaging since the vast majority of HCA remains stable or decreases in size. Pregnancy should not be discouraged provided close sonographic surveillance is undertaken.
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Affiliation(s)
- Safi Dokmak
- Department of Hepatobiliary Surgery and Liver Transplantation Beaujon Hospital, AP-HP, University Paris-Diderot, Clichy, France
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10
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Multiple hepatic adenomas in a child with microvillus inclusion disease. Dig Dis Sci 2013; 58:2784-8. [PMID: 23525737 DOI: 10.1007/s10620-013-2646-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 03/11/2013] [Indexed: 12/16/2022]
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11
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Pathological Diagnosis of Hepatocellular Cellular Adenoma according to the Clinical Context. Int J Hepatol 2013; 2013:253261. [PMID: 23691330 PMCID: PMC3652210 DOI: 10.1155/2013/253261] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 03/01/2013] [Indexed: 02/07/2023] Open
Abstract
In Europe and North America, hepatocellular adenomas (HCA) occur, classically, in middle-aged woman taking oral contraceptives. Twenty percent of women, however, are not exposed to oral contraceptives; HCA can more rarely occur in men, children, and women over 65 years. HCA have been observed in many pathological conditions such as glycogenosis, familial adenomatous polyposis, MODY3, after male hormone administration, and in vascular diseases. Obesity is frequent particularly in inflammatory HCA. The background liver is often normal, but steatosis is a frequent finding particularly in inflammatory HCA. The diagnosis of HCA is more difficult when the background liver is fibrotic, notably in vascular diseases. HCA can be solitary, or multiple or in great number (adenomatosis). When nodules are multiple, they are usually of the same subtype. HNF1 α -inactivated HCA occur almost exclusively in woman. The most important point of the classification is the identification of β -catenin mutated HCA, a strong argument to identify patients at risk of malignant transformation. Some HCA already present criteria indicating malignant transformation. When the whole nodule is a hepatocellular carcinoma, it is extremely difficult to prove that it is the consequence of a former HCA. It is occasionally difficult to identify HCA remodeled by necrosis or hemorrhage.
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12
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Bunchorntavakul C, Bahirwani R, Drazek D, Soulen MC, Siegelman ES, Furth EE, Olthoff K, Shaked A, Reddy KR. Clinical features and natural history of hepatocellular adenomas: the impact of obesity. Aliment Pharmacol Ther 2011; 34:664-74. [PMID: 21762186 DOI: 10.1111/j.1365-2036.2011.04772.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatocellular adenoma is a benign tumour associated with bleeding and malignant transformation. Obesity has been linked to hepatic tumourigenesis. AIM To evaluate the presentation of hepatocellular adenoma in obesity, and the impact of obesity on the clinical course. METHODS Records of 60 consecutive patients (between 2005 and 2010) with a diagnosis of hepatocellular adenoma from a single tertiary centre were analysed. RESULTS Fifty six of 60 patients were women, median age was 36years, 75% had history of contraceptive use, 18% were overweight and 55% were obese (BMI ≥30kg/m(2) ). Majority (63%) were asymptomatic; seven patients presented with bleeding. Single (28%) and multiple adenomas (72%) were encountered; size ranged from 1 to 19.7cm. Obesity was more often associated with multiple adenomas (85% vs. 48%, P=0.005), bilobar distribution (67% vs. 33%, P=0.01), lower serum albumin (P=0.007) and co-morbidities of fatty liver (P=0.006), diabetes (P=0.003), hypertension (P=0.006) and dyslipidemia (P=0.03). During median follow-up of 2.6years, there were no instances of bleeding, malignant transformation or death. Thirty four patients underwent therapeutic intervention (17 surgical resection, nine transarterial embolization and eight both interventions sequentially). The rate of complete resection of adenoma(s) was significantly lower in obese patients (8% vs. 69%, P=0.004). In the 26 patients without intervention, tumour size progression was more frequently observed in obese patients (33% vs. 0%, P=0.05). Three of 15 obese patients (20%) lost ≥5% body weight and there was no progression in the liver lesions. CONCLUSIONS Obesity and features of metabolic syndrome were frequently observed in hepatocellular adenoma. Multiple and bilobar adenomas were more frequent in obese patients. Among patients who were conservatively managed, tumour progression was more often associated with obesity.
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Affiliation(s)
- C Bunchorntavakul
- Division of Gastroenterology and Hepatology and Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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13
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Bioulac-Sage P, Laumonier H, Couchy G, Le Bail B, Sa Cunha A, Rullier A, Laurent C, Blanc JF, Cubel G, Trillaud H, Zucman-Rossi J, Balabaud C, Saric J. Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience. Hepatology 2009; 50:481-9. [PMID: 19585623 DOI: 10.1002/hep.22995] [Citation(s) in RCA: 282] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
UNLABELLED We took advantage of the reported genotype/phenotype classification to analyze our surgical series of hepatocellular adenoma (HCA). The series without specific known etiologies included 128 cases (116 women). The number of nodules varies from single, <5, and >or=5 in 78, 38, and 12 cases, respectively. The resection was complete in 95 cases. We identified 46 HNF1alpha-inactivated HCAs (44 women), 63 inflammatory HCAs (IHCA, 53 women) of which nine were also beta-catenin-activated, and seven beta-catenin-activated HCAs (all women); six additional cases had no known phenotypic marker and six others could not be phenotypically analyzed. Twenty-three of 128 HCAs showed bleeding. No differences were observed in solitary or multiple tumors in terms of hemorrhagic manifestations between groups. In contrast, differences were observed between the two main groups. Steatosis (tumor), microadenomas (resected specimen), and additional benign nodules were more frequently observed in HNF1alpha-inactivated HCAs (P < 0.01) than in IHCAs. Body mass index > 25, peliosis (tumor), and steatosis in background liver were more frequent in IHCA (P < 0.01). After complete resection, new HCAs in the centimetric range were more frequently found during follow-up (>1 year) in HNF1alpha-inactivated HCA. After incomplete resection (HCA left in nonresected liver), the majority of HCA remained stable in the two main groups and even sometimes regressed. Six patients of 128 developed hepatocellular carcinoma (HCC) (all were beta-catenin-activated, whether inflammatory or not). CONCLUSION There were noticeable clinical differences between HNF1alpha-inactivated HCA and IHCA; there was no increased risk of bleeding or HCC related to the number of HCAs; beta-catenin-activated HCAs are at higher risk of HCC. As a consequence, we believe that management of HCA needs to be adapted to the phenotype of these tumors.
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Affiliation(s)
- Paulette Bioulac-Sage
- Service d'Anatomie Pathologique, Hôpital Pellegrin, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France.
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14
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Radiological and histopathological manifestations of hepatocellular nodular lesions concomitant with various congenital and acquired hepatic hemodynamic abnormalities. Jpn J Radiol 2009; 27:53-68. [PMID: 19373534 DOI: 10.1007/s11604-008-0299-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2008] [Accepted: 10/31/2008] [Indexed: 12/25/2022]
Abstract
Congenital and acquired hepatic hemodynamic abnormalities are classified into four categories: hepatic arterial inflow disorder, portal vein inflow disorder, hepatic vein outflow disorder, and presence of a third inflow to the liver. Although their detailed etiology is not fully understood, these hepatic hemodynamic abnormalities may cause the formation of hepatocellular nodules. Recent advances in imaging modalities now enable visualization of these hepatocellular nodules concomitantly with the identification of various congenital and acquired hemodynamic abnormalities. Most of these nodular lesions are benign hyperplastic nodules, such as focal nodular hyperplasia, nodular regenerative hyperplasia, and other types of regenerative nodules. However, neoplastic nodules such as hepatic adenoma and hepatocellular carcinoma may also occur in conjunction with hepatic hemodynamic abnormalities. Distinguishing neoplastic nodules, especially malignant liver tumors, from hyperplastic nodules is important. Detection of intranodular Kupffer cells with superparamagnetic iron oxide enhanced magnetic resonance imaging is a key indicator that a nodule is regenerative rather than neoplastic.
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15
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Abstract
Hepatic adenomatosis was first described in 1985 by Flejou et al as multiple adenomas, arbitrarily more than 10, in an otherwise normal liver parenchyma. Several authors have suggested that it is a distinct entity from hepatic adenoma, which is predominantly seen in young women taking oral contraceptives. Although considered a benign disease, it can be associated with potentially fatal complications such as malignant transformation and intraperitoneal hemorrhage due to rupture. Although its etiology and natural history have not been fully elucidated, germline mutation of hepatocyte nuclear factor 1alpha, which is associated with maturity-onset diabetes of the young type 3, has recently been implicated in a subset of cases. Currently, there is no consensus on patient management. However, surgical removal of large lesions may significantly improve symptoms and reduce the risk of complications. Genetic counseling may now play an important role in case management.
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Affiliation(s)
- Wesley O C Greaves
- Department of Pathology, Rhode Island Hospital and Brown University, Providence, RI 02903, USA.
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16
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Multiple Hepatic Adenomas Associated with Liver Steatosis at CT and MRI: A Case-Control Study. AJR Am J Roentgenol 2008; 191:1430-5. [DOI: 10.2214/ajr.07.3419] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Dhalluin-Venier V, Fabre M, Jacquemin E, Rangheard AS, Pelletier G, Buffet C. Liver cell adenomas and portosystemic shunt. ACTA ACUST UNITED AC 2008; 32:164-6. [DOI: 10.1016/j.gcb.2007.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Seyama Y, Sano K, Tang W, Kokudo N, Sakamoto Y, Imamura H, Makuuchi M. Simultaneous resection of liver cell adenomas and an intrahepatic portosystemic venous shunt with elevation of serum PIVKA-II level. J Gastroenterol 2006; 41:909-12. [PMID: 17048056 DOI: 10.1007/s00535-006-1870-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Accepted: 06/28/2006] [Indexed: 02/04/2023]
Abstract
A 27-year-old woman with no history of liver disease or oral contraceptive use presented with sudden abdominal pain. Laboratory data showed mild liver dysfunction with jaundice. Computed tomography and angiography revealed centrally located large liver cell adenomas (LCAs) and an intrahepatic portosystemic venous shunt (IHPSS) in the left lobe. The serum des-gamma-carboxy prothrombin (known as "protein induced by a lack of vitamin K or antagonist II," PIVKA-II) level was extremely high (6,647 mAU/ml), indicating malignant transformation of the tumors. Under the diagnosis of LCAs and IHPSS, the patient underwent simultaneous resection of the four liver tumors and portovenous shunt, and the hepatic vascular abnormality was resolved. The pathological diagnosis was LCAs without hepatocellular carcinoma. Immunohistochemical analysis with an anti-PIVKA-II monoclonal antibody showed positive staining of the adenoma cells. This case shows that LCA without malignant transformation can produce PIVKA-II, leading to high serum levels of PIVKA-II. Simultaneous resection of multiple tumors and closure of the portosystemic shunt are strongly recommended in a patient with LCA associated with IHPSS.
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Affiliation(s)
- Yasuji Seyama
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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19
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Leone N, Saettone S, De Paolis P, Carucci P, Brunello F, De Angelis C, Menozzi G, Rizzetto M. Ectopic livers and related pathology: report of three cases of benign lesions. Dig Dis Sci 2005; 50:1818-22. [PMID: 16187180 DOI: 10.1007/s10620-005-2944-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2004] [Accepted: 11/09/2004] [Indexed: 02/07/2023]
Affiliation(s)
- Nicola Leone
- Department of Gastroenterology, Molinette Hospital, Turin, Italy.
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20
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Skarupa DJ, Ellison EC, Vitellas KM, Frankel WL. Hepatocellular adenomatosis is a rare entity that may mimic other hepatocellular lesions. Ann Diagn Pathol 2004; 8:43-9. [PMID: 15129911 DOI: 10.1016/j.anndiagpath.2003.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A 14-year-old girl presented to her pediatrician with right lower quadrant pain that progressed to right upper quadrant pain with radiation to her back. Her past medical history included mitral valve prolapse, and she had no history of oral contraceptive use. Abdominal computed tomography revealed a liver mass and multiple smaller areas of low attenuation, too small to characterize. The clinical and radiographic features were suggestive of hepatocellular adenoma, and she underwent a left hepatic lobectomy. The liver contained one 4.2 cm nodule and multiple (10 to 20) smaller nodules that were well-demarcated from the adjacent liver parenchyma. All lesions were histologically hepatocellular adenomas and, therefore, she was diagnosed with hepatocellular adenomatosis. This case is unique because of the small number of cases of hepatocellular adenomatosis diagnosed in teenagers, and little long-term follow-up.
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Affiliation(s)
- David J Skarupa
- Department of Pathology, The Ohio State University Medical Center, Columbus, OH, USA
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21
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Ruiz-López M, Navarro A, Jesús Castro M, Aranda J, Mera S, Cabello A, Pablo ramírez C, de la Fuente A. Adenomatosis hepática como causa excepcional de un hemoperitoneo espontáneo en el varón. Cir Esp 2004. [DOI: 10.1016/s0009-739x(04)72271-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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22
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Lepreux S, Laurent C, Blanc JF, Trillaud H, Le Bail B, Trouette H, Saric J, Zucman-Rossi J, Balabaud C, Bioulac-Sage P. The identification of small nodules in liver adenomatosis. J Hepatol 2003; 39:77-85. [PMID: 12821047 DOI: 10.1016/s0168-8278(03)00145-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS Liver adenomatosis is characterized by the presence of multiple adenomas of various sizes in the liver. The aim of this study was to characterize the morphology of small nodules which can be difficult to identify. METHODS Seven patients included in this study underwent surgery for the removal of one or several nodules. All, but one, were females. Three out of seven presented with acute bleeding. Five had six or more nodules at presentation, and two only one, who developed nodules later on during follow-up. RESULTS All of the large nodules that were >2 cm, except one, were typical adenomas with or without hemorrhagic areas. Smaller nodules (1-2 cm), some of which discovered on the resected specimen were either typical adenomas or non-typical nodules. These non-typical nodules were characterized by a polylobulated aspect with steatotic zones, and in between, bands of non-steatotic hepatocytes with portal tracts-like structures containing occasional cytokeratin 7 and less often cytokeratin 19 positive biliary cells. Numerous steatotic foci were also seen in four cases. They were isolated or grouped forming microadenomas or non-typical micronodules (<1 cm) containing biliary elements. Our findings lead to the following hypothesis: adenomatosis is characterized by the simultaneous occurrence of multiple adenomas; if several adenomatous foci expand at the same time in the same area, they will form one polylobulated nodule containing non-adenomatous tissue with portal tracts in between areas of adenomatous tissue (non-typical micronodule). Such a small micronodule may in turn expand and join another micronodule to form a bigger one by the same process (non-typical nodule). As nodules grow, their non-adenomatous components including hepatocytic plates and portal tracts constituents will progressively disappear to end up with the classical aspect of an adenoma. CONCLUSIONS This hypothesis supports the concept that non-typical nodules/micronodules are adenomas precursors. However, they can be difficult to classify since they resemble focal nodular hyperplasia precursor.
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23
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Tanoue S, Kiyosue H, Komatsu E, Hori Y, Maeda T, Mori H. Symptomatic intrahepatic portosystemic venous shunt: embolization with an alternative approach. AJR Am J Roentgenol 2003; 181:71-8. [PMID: 12818832 DOI: 10.2214/ajr.181.1.1810071] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Intrahepatic portosystemic venous shunt is relatively rare and not well recognized. Awareness of intrahepatic communications is important because they can cause encephalopathy, and most of these shunts can be completely cured by transcatheter embolization. In this study, we describe the angiographic findings and transcatheter embolization techniques using several approaches for the treatment of intrahepatic portosystemic venous shunt. MATERIALS AND METHODS Between 1989 and 2001, we treated 10 patients with symptomatic intrahepatic portosystemic venous shunt by performing transcatheter embolization with Gianturco coils, fibered platinum coils, detachable balloons, and detachable microcoils using one of three approaches to access the portal venous system: transileocolic obliteration (n = 2), percutaneous transhepatic obliteration (n = 4), or retrograde transcaval obliteration (n = 4). RESULTS In all patients, complete obliteration or nearly complete obliteration was confirmed angiographically, and symptoms related to portal-systemic encephalopathy improved after treatment. Complications were observed in three patients: adhesive ileus in a patient treated by transileocolic obliteration and thrombosis of intrahepatic portal branches in two patients treated by percutaneous transhepatic obliteration. CONCLUSION On angiography, two types of intrahepatic portosystemic venous shunt were seen: intrahepatic portal venous-hepatic venous communication and intrahepatic portal venous-perihepatic venous communication. Transcatheter embolization is effective for treatment of intrahepatic portosystemic venous shunt. Retrograde transcaval obliteration is the least invasive technique and is recommended as the first choice for treatment of portosystemic venous shunt except in patients with multiple shunts.
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Affiliation(s)
- Shuichi Tanoue
- Department of Radiology, Oita Medical University, 1-1, Idaigaoka, Hasama-machi, Oita-gun, Oita, 879-5593, Japan
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Grazioli L, Federle MP, Brancatelli G, Ichikawa T, Olivetti L, Blachar A. Hepatic adenomas: imaging and pathologic findings. Radiographics 2001; 21:877-92; discussion 892-4. [PMID: 11452062 DOI: 10.1148/radiographics.21.4.g01jl04877] [Citation(s) in RCA: 278] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Hepatocellular adenoma is a rare benign lesion that is most often seen in young women with a history of oral contraceptive use. It is typically solitary, although multiple lesions have been reported, particularly in patients with glycogen storage disease and liver adenomatosis. Because of the risk of hemorrhage and malignant transformation, hepatocellular adenomas must be identified and treated promptly. At pathologic analysis, hepatocellular adenoma is usually a well-circumscribed, nonlobulated lesion, and at gross examination, resected adenomas frequently demonstrate areas of hemorrhage and infarction. Most adenomas are not specifically diagnosed at ultrasonography (US) and are usually further evaluated with computed tomography (CT) or other imaging modalities. Color Doppler US may help differentiate hepatocellular adenoma from focal nodular hyperplasia. Multiphasic helical CT allows more accurate detection and characterization of focal hepatic lesions. Hepatocellular adenomas are typically bright on T1-weighted magnetic resonance images and predominantly hyperintense relative to liver on T2-weighted images. The prognosis of hepatic adenoma is not well established. Criteria that guide treatment include the number and size of the lesions, the presence of symptoms, and the surgical risk incurred by the patient. Understanding the imaging appearance of hepatocellular adenoma can help avoid misdiagnosis and facilitate prompt, effective treatment.
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Affiliation(s)
- L Grazioli
- Department of Radiology, University of Brescia, Brescia, Italy
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Grazioli L, Federle MP, Ichikawa T, Balzano E, Nalesnik M, Madariaga J. Liver adenomatosis: clinical, histopathologic, and imaging findings in 15 patients. Radiology 2000; 216:395-402. [PMID: 10924560 DOI: 10.1148/radiology.216.2.r00jl38395] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To report and correlate the clinical, histopathologic, and imaging findings in 15 patients with liver adenomatosis. MATERIALS AND METHODS Fifteen adult patients had more than 10 hepatic adenomas each and no history of glycogen storage disease or anabolic steroid use. Ten of them underwent bolus-enhanced dynamic computed tomography (CT) with or without magnetic resonance (MR) imaging, ultrasonography, and/or angiography. RESULTS Clinical abnormalities included abdominal pain in 11 (73%) and hepatomegaly in 10 (67%) patients, and abnormal liver function in 10 (91%) of 11 patients. The number of adenomas in each patient was 10-50 at imaging, but many more lesions were found in the resected specimens. Hemorrhage was commonly found within adenomas at histopathologic analysis, but only four patients had clinical and imaging evidence of substantial hemorrhage. In all patients, the adenomas increased over time, and two patients developed hepatocellular carcinoma. CT and MR features of the adenomas included evidence of hypervascularity (63%), intratumoral fat (50% of patients at CT, 80% at MR), and decreased conspicuity at portal venous and delayed-phase imaging. Fifty percent of patients had congenital or acquired hepatic vascular abnormalities. CONCLUSION The imaging and histopathologic features of individual adenomatous lesions are similar to those reported in young women who are taking oral contraceptives. However, the lesions in liver adenomatosis are not steroid dependent but rather multiple, progressive, and symptomatic, and they are more likely to lead to impaired liver function, hemorrhage, and perhaps malignant degeneration.
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Affiliation(s)
- L Grazioli
- Departments of Radiology, University of Pittsburgh Medical Center, Presbyterian Hospital, 200 Lothrop St, Room 4660 CHP MT, Pittsburgh, PA 15213, USA
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26
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Chiche L, Dao T, Salamé E, Galais MP, Bouvard N, Schmutz G, Rousselot P, Bioulac-Sage P, Ségol P, Gignoux M. Liver adenomatosis: reappraisal, diagnosis, and surgical management: eight new cases and review of the literature. Ann Surg 2000; 231:74-81. [PMID: 10636105 PMCID: PMC1420968 DOI: 10.1097/00000658-200001000-00011] [Citation(s) in RCA: 147] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Liver adenomatosis (LA) is a rare disease originally defined by Flejou et al in 1985 from a series of 13 cases. In 1998, 38 cases were available for analysis, including eight personal cases. The aim of this study was to review and reappraise the characteristics of this rare liver disease and to discuss diagnosis and therapeutic options. BACKGROUND LA was defined as the presence of >10 adenomas in an otherwise normal parenchyma. Neither female predominance nor a relation with estrogen/progesterone intake has been noted. Natural progression is poorly known. METHODS The clinical presentation, evolution, histologic characteristics, and therapeutic options and results were analyzed based on a personal series of eight new cases and an updated review of the literature. RESULTS From a diagnostic standpoint, two forms of liver adenomatosis with different presentations and evolution can be defined: a massive form and a multifocal form. The role of estrogen and progesterone is reevaluated. The risks of hemorrhage and malignant transformation are of major concern. In the authors' series, liver transplantation was indicated in two young women with the massive, aggressive form, and good results were obtained. CONCLUSION Liver adenomatosis is a rare disease, more common in women, where outcome and evolution vary and are exacerbated by estrogen intake. Most often, conservative surgery is indicated. Liver transplantation is indicated only in highly symptomatic and aggressive forms of the disease.
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Affiliation(s)
- L Chiche
- Department of Hepatobiliary Surgery, University Hospital of Caen, France
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Kaji K, Kaneko S, Matsushita E, Kobayashi K, Matsui O, Nakanuma Y. A case of progressive multiple focal nodular hyperplasia with alteration of imaging studies. Am J Gastroenterol 1998; 93:2568-72. [PMID: 9860429 DOI: 10.1111/j.1572-0241.1998.00721.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Focal nodular hyperplasia (FNH) of the liver is a lesion characterized by a well circumscribed region of hyperplastic liver tissue with stellate fibrosis. The pathogenesis of the lesion is unknown but various authors consider that FNH may be a response to a preexisting vascular abnormality. We experienced a case of progressive multiple FNH, in which the hemodynamic change as shown by imaging modalities, may support this hypothesis. The patient, a 38-yr-old woman, was found by chance to have multiple portal venous shunts and multiple FNH in both lobes of her liver. Because of their benign characteristics, we followed the nodules periodically without any special treatment. After about 4 yr, the nodules increased both in size and number. In addition, digital subtraction angiography showed that the diameter of the artery had become larger. The hemodynamic change revealed by imaging studies in this case supports the hypothesis that one of the pathogens of FNH is a secondary hepatocellular response to arterial hyperperfusion caused by some vascular malformations.
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Affiliation(s)
- K Kaji
- Department of Internal Medicine (I), Kanazawa University School of Medicine, Japan
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28
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Ribeiro A, Burgart LJ, Nagorney DM, Gores GJ. Management of liver adenomatosis: results with a conservative surgical approach. LIVER TRANSPLANTATION AND SURGERY : OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION FOR THE STUDY OF LIVER DISEASES AND THE INTERNATIONAL LIVER TRANSPLANTATION SOCIETY 1998; 4:388-98. [PMID: 9724476 DOI: 10.1002/lt.500040505] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Liver adenomatosis is defined by the presence of multiple hepatic adenomas (more than three lesions). The natural history and treatment of liver adenomatosis are not yet well defined. The Mayo Clinic (Rochester, MN) experience with liver adenomatosis in the past 11 years was reviewed and a rational treatment approach is presented. Records from patients with liver adenomatosis and hepatic adenoma seen at the Mayo Clinic from January 1986 to June 1997 were reviewed. Estrogen- and progesterone-receptor status was assessed by immunohistochemistry. Eight women with liver adenomatosis were identified. All patients had undergone surgical treatment. Abdominal pain was the presenting symptom in 87.5% of the patients with adenomatosis and in 42.1% of the patients with hepatic adenoma. Tumor bleeding was present in 62.5% of the patients with adenomatosis and in 26.3% of the patients with hepatic adenomas. Bleeding occurred predominantly in lesions greater than 4 cm. All patients with liver adenomatosis reported improvement of symptoms after surgery, and the mean bleeding-free period after resection in 5 patients was 52.6 +/- 23.6 months. In 6 patients, estrogen receptor-positive and estrogen receptor-negative tumors were identified in the same liver. Based on the good outcome after resection in symptomatic patients with liver adenomatosis, we recommend resection of large (>/=5 cm) or symptomatic lesions with observation of smaller lesions (</=3 cm). Lack of estrogen receptors in many lesions suggests that estrogen does not play a dominant role in the pathogenesis of liver adenomatosis.
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Affiliation(s)
- A Ribeiro
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
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