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Aziz H, Underwood PW, Gosse MD, Afyouni S, Kamel I, Pawlik TM. Hepatic adenoma: evolution of a more individualized treatment approach. J Gastrointest Surg 2024; 28:975-982. [PMID: 38521190 DOI: 10.1016/j.gassur.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/07/2024] [Accepted: 03/09/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Hepatic adenomas (HAs) are benign, solid liver lesions, which carry a risk of hemorrhage and malignant transformation. This review article highlights the advances in the diagnosis and management of HAs. METHODS A comprehensive review was performed using MEDLINE/PubMed and Web of Science databases with a search period ending on September 30, 2023. Using PubMed, the terms "hepatocellular," "hepatic," and "adenoma" were searched. RESULTS HA has been classified into at least 8 subtypes based on molecular pathology, each exhibiting unique histopathologic features, clinical considerations, and risk of malignant transformation. The most common subtype is inflammatory HA, followed by hepatocyte nuclear factor 1α-inactivated HA, β-catenin exon 3-mutated HA (βex3-HA), β-catenin exon 7- or 8-mutated HA, sonic hedgehog HA, and unclassified HA. Magnetic resonance imaging is the best imaging method for diagnosis and can distinguish among HA subtypes based on fat and telangiectasia pathologic characteristics. The risk of malignant transformation varies among molecular subtypes, ranging from <1% to approximately 50%. Up to 42% of HAs present with spontaneous intratumoral hemorrhage and peritoneal hemorrhage. In general, only 15% to 20% of patients require surgery. HA larger than 5 cm are more likely to be complicated by bleeding and malignant transformation, regardless of subtype, and should generally be resected. In particular, βex3-HA carries a high risk of malignant transformation and can be considered a true precancerous lesion. CONCLUSION The management of HAs is based on a multidisciplinary approach. Clinical decision-making should integrate information on gender, tumor size, and HA subtyping. In the future, patients with HA will benefit from novel medical therapies tailored to the individual molecular subtypes.
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Affiliation(s)
- Hassan Aziz
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
| | - Patrick W Underwood
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Matthew D Gosse
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
| | - Shadi Afyouni
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Ihab Kamel
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States.
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Zhang Z, Ji J, Qiu G, Hou Z, Mi S, Jin Z, Dai Y, Xie Q, Zeng Y, Huang J. Surgical indications for solid hepatic benign tumors: An updated literature review. Biosci Trends 2023; 17:325-334. [PMID: 37599079 DOI: 10.5582/bst.2023.01152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Hepatic hemangioma, focal nodular hyperplasia, and hepatic adenoma are the most common benign solid liver tumors. However, their surgical indications have been the subject of debate. Minimally invasive liver resection reduces the cost of surgery and may lead to overtreatment of benign liver tumors. Recently, there has been a growing understanding of the etiology, pathogenesis, and natural history of these tumors. Great progress has also been made in imaging. The use of MRI and contrast agents has improved the accuracy of non-invasive diagnosis of these tumors, and especially in the identification of specific molecular subtypes of liver adenoma. These factors have resulted in alterations of surgical indications for these tumors. This article examines recent literature and it discusses the surgical indications for hepatic hemangioma, focal nodular hyperplasia, and hepatic adenoma while summarizing modifications in clinical management.
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Affiliation(s)
- Zhihong Zhang
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jun Ji
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Guoteng Qiu
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ziqi Hou
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Shizheng Mi
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhaoxing Jin
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yunlong Dai
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qingyun Xie
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Zeng
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jiwei Huang
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
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Cacciatori FA, Rodrigues PD, Fontes PRO. Bleeding hepatocellular adenoma: historical series and outcomes. Rev Col Bras Cir 2023; 50:e20233549. [PMID: 37436285 PMCID: PMC10508653 DOI: 10.1590/0100-6991e-20233549-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/01/2023] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION hepatocellular adenoma - AHC - is a rare benign neoplasm of the liver more prevalent in women at reproductive age and its main complication is hemorrhage. In the literature, case series addressing this complication are limited. METHODS between 2010 and 2022, 12 cases of bleeding AHC were attended in a high-complexity university hospital in southern Brazil, whose medical records were retrospectively evaluated. RESULTS all patients were female, with a mean age of 32 years and a BMI of 33kg/m2. The use of oral contraceptives was identified in half of the sample and also half of the patients had a single lesion. The mean diameter of the largest lesion was 9.60cm and the largest lesion was responsible for bleeding in all cases. The presence of hemoperitoneum was documented in 33% of the patients and their age was significantly higher than the patients who did not have hemoperitoneum - 38 vs 30 years, respectively. Surgical resection of the bleeding lesion was performed in 50% of the patients and the median number of days between bleeding and resection was 27 days. In only one case, embolization was used. The relation between ingrowth of the lesions and the time, in months, was not obtained in this study. CONCLUSION it is concluded that the bleeding AHC of the present series shows epidemiological agreement with the literature and may suggest that older patients trend to have hemoperitoneum more frequently, a fact that should be investigated in further studies.
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Affiliation(s)
- Felipe Antônio Cacciatori
- - Santa Casa de Misericórdia, Serviço de Cirurgia Hepatobiliopancreática e Transplante Hepático - Porto Alegre - RS - Brasil
| | - Pablo Duarte Rodrigues
- - Santa Casa de Misericórdia, Serviço de Cirurgia Hepatobiliopancreática e Transplante Hepático - Porto Alegre - RS - Brasil
| | - Paulo Roberto Ott Fontes
- - Santa Casa de Misericórdia, Serviço de Cirurgia Hepatobiliopancreática e Transplante Hepático - Porto Alegre - RS - Brasil
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Tse JR, Felker ER, Naini BV, Shen L, Shen J, Lu DSK, Kamaya A, Raman SS. Hepatocellular Adenomas: Molecular Basis and Multimodality Imaging Update. Radiographics 2023; 43:e220134. [PMID: 36821508 DOI: 10.1148/rg.220134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Hepatocellular adenomas (HCAs) are a family of liver tumors that are associated with variable prognoses. Since the initial description of these tumors, the classification of HCAs has expanded and now includes eight distinct genotypic subtypes based on molecular analysis findings. These genotypic subtypes have unique derangements in their cellular biologic makeup that determine their clinical course and may allow noninvasive identification of certain subtypes. Multiphasic MRI performed with hepatobiliary contrast agents remains the best method to noninvasively detect, characterize, and monitor HCAs. HCAs are generally hypointense during the hepatobiliary phase; the β-catenin-mutated exon 3 subtype and up to a third of inflammatory HCAs are the exception to this characterization. It is important to understand the appearances of HCAs beyond their depictions at MRI, as these tumors are typically identified with other imaging modalities first. The two most feared related complications are bleeding and malignant transformation to hepatocellular carcinoma, although the risk of these complications depends on tumor size, subtype, and clinical factors. Elective surgical resection is recommended for HCAs that are persistently larger than 5 cm, adenomas of any size in men, and all β-catenin-mutated exon 3 HCAs. Thermal ablation and transarterial embolization are potential alternatives to surgical resection. In the acute setting of a ruptured HCA, patients typically undergo transarterial embolization with or without delayed surgical resection. This update on HCAs includes a review of radiologic-pathologic correlations by subtype and imaging modality, related complications, and management recommendations. © RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Justin R Tse
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Ely R Felker
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Bita V Naini
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Luyao Shen
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Jody Shen
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - David S K Lu
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Aya Kamaya
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Steven S Raman
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
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Julien C, Le Bail B, Balabaud C, Bioulac-Sage P. Risk factors for bleeding hepatocellular adenoma. Liver Int 2022; 42:947-948. [PMID: 35129283 DOI: 10.1111/liv.15184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- Céline Julien
- Department of Digestive Surgery, University Bordeaux Hospital, Bordeaux, France
| | - Brigitte Le Bail
- Department of Pathology, University Bordeaux Hospital, Bordeaux, France.,INSERM, BRIC, University Bordeaux, Bordeaux, France
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