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Ching AS, Zhang X, Furuya KN, Benoy ME, Bartlett HL. Turner syndrome may be associated with hepatic adenoma. Am J Med Genet A 2023; 191:2578-2584. [PMID: 37431210 DOI: 10.1002/ajmg.a.63341] [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: 10/17/2022] [Revised: 04/12/2023] [Accepted: 06/09/2023] [Indexed: 07/12/2023]
Abstract
Turner syndrome, caused by complete or partial loss of an X chromosome, is marked by a range of clinical manifestations including short stature, cardiovascular and renal disease. Hepatic involvement is an increasingly recognized concern. Steatosis and elevated transaminases are commonly observed in this population, but case reports have also described hepatic adenoma. Hepatic adenomas are rare, occurring in one per million people in the general population. They are typically benign but malignant transformation or rupture can occur. We sought to investigate whether Turner syndrome is associated with hepatic adenoma. Patients with Turner syndrome encountered at a single, academic institution between 2006 and 2020 were identified using ICD-10 codes and demographic, medication, laboratory, and imaging data were analyzed. Of the 228 patients identified, 46.9% had liver function testing, which were abnormal in 48.6%. Five of 77 patients with hepatic imaging had abnormalities. Three patients (1.3%) had hepatic adenoma, one after presenting in hemorrhagic shock due to rupture. These findings suggest that patients with Turner syndrome may have an increased risk for developing hepatic adenoma. Annual monitoring of liver function tests is already recommended in Turner syndrome. The addition of periodic hepatic imaging may also be beneficial.
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Affiliation(s)
- Alisha S Ching
- Department of Pediatrics, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Xiao Zhang
- Department of Pediatrics, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Katryn N Furuya
- Department of Pediatrics, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Megan E Benoy
- Department of Pediatrics, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Heather L Bartlett
- Department of Pediatrics, University of Wisconsin - Madison, Madison, Wisconsin, USA
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2
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Hahn E, Putra J. Hepatocellular adenoma in the paediatric population: Molecular classification and clinical associations. World J Gastroenterol 2020; 26:2294-2304. [PMID: 32476794 PMCID: PMC7243640 DOI: 10.3748/wjg.v26.i19.2294] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/29/2020] [Accepted: 04/30/2020] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular adenomas (HCAs) represent rare, benign liver tumours occurring predominantly in females taking oral contraceptives. In children, HCAs comprise less than 5% of hepatic tumours and demonstrate association with various conditions. The contemporary classification of HCAs, based on their distinctive genotypes and clinical phenotypes, includes hepatocyte nuclear factor 1 homeobox alpha-inactivated HCAs, beta-catenin-mutated HCAs, inflammatory HCAs, combined beta-catenin-mutated and inflammatory HCAs, sonic hedgehog-activated HCAs, and unclassified HCAs. In children, there is a lack of literature on the characteristics and distribution of HCA subtypes. In this review, we summarized different HCA subtypes and the clinicopathologic spectrum of HCAs in the paediatric population.
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Affiliation(s)
- Elan Hahn
- Division of Pathology, Department of Paediatric Laboratory Medicine, the Hospital for Sick Children, Toronto M5G 1X8, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto M5S 1A8, ON, Canada
| | - Juan Putra
- Division of Pathology, Department of Paediatric Laboratory Medicine, the Hospital for Sick Children, Toronto M5G 1X8, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto M5S 1A8, ON, Canada
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3
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Nemoto S, Ariizumi SI, Kotera Y, Omori A, Yamashita S, Kato TA, Aoyama S, Egawa H, Yamamoto M. Inflammatory hepatocellular adenoma in a patient with Turner's syndrome: A case report. Int J Surg Case Rep 2019; 56:5-9. [PMID: 30798096 PMCID: PMC6389595 DOI: 10.1016/j.ijscr.2019.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 02/09/2023] Open
Abstract
INTRODUCTION Hepatocellular adenoma (HCA) is a rare benign tumor and is related to the use of an oral contraceptive pill. Turner's syndrome requires various hormone replacement therapies, including the pill which is used as a female hormone replacement therapy. Herein we report a case of Turner's syndrome with HCA treated by liver segmentectomy. PRESENTATION OF CASE A 36-year-old woman with Turner's syndrome was treated with oral contraceptive pills as a female hormone replacement therapy for 20 years. She presented with fatigue and liver tumor. Liver tumors in the posterior lobe measuring 60 mm and 10 mm in diameter were detected on CT; hence, she was referred to our department. Both the tumors showed high intensity in the arterial phase, iso-intensity in the portal and late phases, and low intensity in the hepatobiliary phase on Gb-EOB-MRI. She was diagnosed with multiple HCAs and underwent segmentectomy Section 7. Pathologically, both the tumors were diagnosed as HCAs, and inflammatory markers were detected by immunohistochemistry. Thirteen months postoperatively, she was doing well and there was no evidence of recurrence of HCA without the pill. DISCUSSION There is only one report of HCA in patients with TS (Espat et al., 2000). We reported a case of multiple HCAs in a patient with TS underwent hepatectomy. CONCLUSION With the use of the contraceptive pill as a long-term female hormone replacement therapy for Turner's syndrome, careful attention is required for HCA.
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Affiliation(s)
- Satoshi Nemoto
- Department of Gastroenterology Surgery, Tokyo Women's Medical University, Japan.
| | - Shun-Ichi Ariizumi
- Department of Gastroenterology Surgery, Tokyo Women's Medical University, Japan.
| | - Yoshihito Kotera
- Department of Gastroenterology Surgery, Tokyo Women's Medical University, Japan
| | - Akiko Omori
- Department of Gastroenterology Surgery, Tokyo Women's Medical University, Japan
| | - Shingo Yamashita
- Department of Gastroenterology Surgery, Tokyo Women's Medical University, Japan
| | - Taka-Aki Kato
- Department of Gastroenterology Surgery, Tokyo Women's Medical University, Japan
| | - Shota Aoyama
- Department of Gastroenterology Surgery, Tokyo Women's Medical University, Japan
| | - Hiroto Egawa
- Department of Gastroenterology Surgery, Tokyo Women's Medical University, Japan
| | - Masakazu Yamamoto
- Department of Gastroenterology Surgery, Tokyo Women's Medical University, Japan
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4
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Law JR, Lee S, Sasatomi E, Bookhout CE, Blatt J. Hepatocellular Carcinoma, Virilization, and Hilus Cell Hyperplasia in a Girl With Turner Syndrome. J Endocr Soc 2018; 2:471-475. [PMID: 29732458 PMCID: PMC5932469 DOI: 10.1210/js.2018-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/10/2018] [Indexed: 11/24/2022] Open
Abstract
Patients with Turner syndrome (TS) are known to be at risk for excess androgen production and virilization associated with gonadoblastoma and Y chromosome mosaicism, and excess androgens are a risk factor for the development of hepatocellular carcinoma. However, virilization and hepatocellular carcinoma have not been described in a patient with TS. A 10-year-old with nonmosaic 45,X TS presented with clitoromegaly, accelerated linear growth velocity, advanced bone age, and elevated testosterone levels as well as a second occurrence of hepatocellular carcinoma. Gonadectomy was performed, and pathology revealed hilus cell hyperplasia. Immunohistochemical staining of both the original and recurrent hepatocellular carcinoma tissues was diffusely positive for androgen receptors. After gonadectomy, testosterone levels were measurable but normal, with no further virilization; however, the liver mass continued to grow. Ovarian hilus cell hyperplasia should be considered a potential etiology for virilization in the TS population. Excess endogenous testosterone exposure in girls and women with TS may be associated with hepatocellular carcinoma expressing the androgen receptor, though normalizing testosterone levels may not lead to tumor regression in these cases.
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Affiliation(s)
- Jennifer R Law
- Division of Pediatric Endocrinology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sang Lee
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Eizaburo Sasatomi
- Department of Surgical Pathology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christine E Bookhout
- Department of Surgical Pathology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Julie Blatt
- Pediatric Hematology Oncology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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5
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Liu D, Liu P, Cao L, Zhang Q, Chen Y. Screening the key genes of hepatocellular adenoma via microarray analysis of DNA expression and methylation profiles. Oncol Lett 2017; 14:3975-3980. [PMID: 28943905 PMCID: PMC5605960 DOI: 10.3892/ol.2017.6673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 05/23/2017] [Indexed: 01/30/2023] Open
Abstract
The aim of the present study was to identify the biomarkers involved in the development of hepatocellular adenoma (HCA) through integrated analysis of gene expression and methylation microarray. The microarray dataset GSE7473, containing HNF1α-mutated HCA and their corresponding non-tumor livers, 5 HNF1α-mutated HCA and 4 non-related non-tumor livers, was downloaded from the Gene Expression Omnibus (GEO) database. The DNA methylation profile GSE43091, consisting of 50 HCA and 4 normal liver tissues, was also downloaded from the GEO database. Differentially expressed genes (DEGs) were identified by the limma package of R. A t-test was conducted on the differentially methylated sites. Functional enrichment analysis of DEGs was performed through the Database for Annotation, Visualization and Integrated Analysis. The genes corresponding to the differentially methylated sites were obtained by the annotation files of methylation chip platform. A total of 182 DEGs and 3,902 differentially methylated sites were identified in HCA. In addition, 238 enriched GO terms, including organic acid metabolic process and carboxylic acid metabolic process, and 14 KEGG pathways, including chemical carcinogenesis, were identified. Furthermore, 12 DEGs were identified to contain differentially methylated sites, among which, 8 overlapped genes, including pregnancy zone protein and solute carrier family 22 member 1 (SLC22A1), exhibited inverse associations between gene expression levels and DNA methylation levels. The DNA methylation levels may be potential targets of HCA. The present study revealed that the 8 overlapped genes, including annexin A2, chitinase 3-like 1, fibroblast growth factor receptor 4, mal, T-cell differentiation protein like, palladin, cytoskeletal associated protein, plasmalemma vesicle associated protein and SLC22A1, may be potential therapeutic targets of HCA.
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Affiliation(s)
- Dan Liu
- Department of Ultrasonic Imaging, Zhuhai People's Hospital, Zhuhai, Guangdong 519000, P.R. China
| | - Pengfei Liu
- Department of Lymphoma, Sino-US Center of Lymphoma and Leukemia, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China
| | - Liye Cao
- Department of Ultrasonic Medicine, Affiliated Hospital of Hebei University, Baoding, Hebei 071000, P.R. China
| | - Quan Zhang
- Department of Hepatobiliary Surgery, Affiliated Hospital of Hebei University, Baoding, Hebei 071000, P.R. China
| | - Yaqing Chen
- Department of VIP Ward, Affiliated Hospital of Hebei University, Baoding, Hebei 071000, P.R. China
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6
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van Rosmalen BV, Coelen RJS, Bieze M, van Delden OM, Verheij J, Dejong CHC, van Gulik TM. Systematic review of transarterial embolization for hepatocellular adenomas. Br J Surg 2017; 104:823-835. [DOI: 10.1002/bjs.10547] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/02/2016] [Accepted: 02/22/2017] [Indexed: 02/06/2023]
Abstract
Abstract
Background
Hepatocellular adenoma (HCA) larger than 5 cm in diameter is considered an indication for elective surgery, because of the risk of haemorrhage and malignant transformation. Transarterial embolization (TAE) is used to manage bleeding HCA and occasionally to reduce tumour size. TAE might have potential as an elective therapy, but its current role in this context is uncertain. This systematic review provides an overview of clinical outcomes after TAE, in bleeding and non-bleeding HCA.
Methods
Two independent reviewers performed a systematic search of literature in PubMed and Embase. Outcomes were change in tumour size, avoidance of surgery, complications and malignant transformation after TAE in bleeding and non-bleeding HCA. The Critical Appraisal Skills Programme tool for cohort studies was used for quality assessment of included studies.
Results
From 320 potential articles, 20 cohort studies and 20 case reports including 851 patients met the inclusion criteria. TAE was performed in 151 of 851 patients (17·7 per cent), involving 196 tumours, of which 95 (48·5 per cent) were non-bleeding. Surgical treatment was avoided in 68 of 151 patients (45·0 per cent). Elective TAE was performed in 49 patients involving 66 HCAs, with 41 of these patients (84 per cent) not requiring surgery. Major complications occurred in eight of 151 patients (5·3 per cent); no death was reported. Among cohort studies, complete tumour disappearance was observed in 10 per cent of patients, and regression in 75 per cent.
Conclusion
Acute or elective TAE in the management of HCA is safe. In the elective setting, TAE provides a potential alternative to surgery.
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Affiliation(s)
- B V van Rosmalen
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - R J S Coelen
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - M Bieze
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - O M van Delden
- Department of Interventional Radiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - J Verheij
- Department of Pathology, Academic Medical Centre, Amsterdam, The Netherlands
| | - C H C Dejong
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - T M van Gulik
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
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Larizza D, Albanesi M, De Silvestri A, Accordino G, Brazzelli V, Maffè GC, Calcaterra V. Neoplasia in Turner syndrome. The importance of clinical and screening practices during follow-up. Eur J Med Genet 2016; 59:269-73. [PMID: 27058262 DOI: 10.1016/j.ejmg.2016.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 03/31/2016] [Indexed: 11/24/2022]
Abstract
AIM OF THE STUDY Turmer syndrome (TS) patients show increased morbidity due to metabolic, autoimmune and cardiovascular disorders. A risk of neoplasia is also reported. Here, we review the prevalence of neoplasia in a cohort of Turner patients. METHODS We retrospectively evaluated 87 TS women. Follow-up included periodic ultrasound of the neck, abdominal and pelvic organs, dermatologic evaluation and fecal occult blood test. Karyotype was 45,X in 46 patients. During follow-up, 63 girls were treated with growth hormone, 65 with estro-progestin replacement therapy and 20 with L-thyroxine. Autoimmune diseases were present in 29 TS. RESULTS A total of 17 neoplasms in 14 out of 87 patients were found. Six skin neoplasia, 3 central nervous system tumors, 3 gonadal neoplasia, 2 breast tumors, 1 hepatocarcinoma, 1 carcinoma of the pancreas and 1 follicular thyroid cancer were detected. Age at tumor diagnosis was higher in 45,X pts than in those with other karyotypes (p = 0.003). Adenomioma gallbladdder (AG) was detected in 15.3% of the patients, with a lower age in girls at diagnosis with an associated neoplasia in comparison with TS without tumors (p = 0.017). No correlation between genetic make up, treatment, associated autoimmune diseases and neoplastia was found. CONCLUSION In our TS population an increased neoplasia prevalence was reported. A high prevalence of AG was also noted and it might be indicative of a predisposition to neoplasia. Further studies are needed to define the overall risk for neoplasia, and to determine the role of the loss of the X-chromosome and hormonal therapies.
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Affiliation(s)
- Daniela Larizza
- Pediatric Endocrinology Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo Pavia and Department of Internal Medicine, University of Pavia, Italy.
| | - Michela Albanesi
- Pediatric Endocrinology Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo Pavia and Department of Internal Medicine, University of Pavia, Italy
| | - Annalisa De Silvestri
- Biometry & Clinical Epidemiology, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulia Accordino
- Pediatric Endocrinology Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo Pavia and Department of Internal Medicine, University of Pavia, Italy
| | - Valeria Brazzelli
- Institute of Dermatology, Department of Clinical-Surgical, Diagnostic and Pediatric Science, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gabriella Carnevale Maffè
- 1st Department of Internal Medicine, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valeria Calcaterra
- Pediatric Endocrinology Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo Pavia and Department of Internal Medicine, University of Pavia, Italy
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8
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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: 66] [Impact Index Per Article: 7.3] [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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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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Melis D, Della Casa R, Balivo F, Minopoli G, Rossi A, Salerno M, Andria G, Parenti G. Involvement of endocrine system in a patient affected by glycogen storage disease 1b: speculation on the role of autoimmunity. Ital J Pediatr 2014; 40:30. [PMID: 24646511 PMCID: PMC3974180 DOI: 10.1186/1824-7288-40-30] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 02/27/2014] [Indexed: 11/14/2022] Open
Abstract
Glycogen storage disease type 1b (GSD1b) is an inherited metabolic defect of glycogenolysis and gluconeogenesis due to mutations of the SLC37A4 gene and to defective transport of glucose-6-phosphate. The clinical presentation of GSD1b is characterized by hepatomegaly, failure to thrive, fasting hypoglycemia, and dyslipidemia. Patients affected by GSD1b also show neutropenia and/or neutrophil dysfunction that cause increased susceptibility to recurrent bacterial infections. GSD1b patients are also at risk for inflammatory bowel disease. Occasional reports suggesting an increased risk of autoimmune disorders in GSD1b patients, have been published. These complications affect the clinical outcome of the patients. Here we describe the occurrence of autoimmune endocrine disorders including thyroiditis and growth hormone deficiency, in a patient affected by GSD1b. This case further supports the association between GSD1b and autoimmune diseases.
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Affiliation(s)
- Daniela Melis
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Via S, Pansini 5, 80131 Naples, Italy.
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Abstract
Liver dysfunction is commonly seen in women with Turner syndrome and can manifest in a variety of pathologies. In this review, we discuss the spectrum of liver anomalies associated with this syndrome, and discuss some possible aetiological factors and relationships with exogenous oestrogen.
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Affiliation(s)
- Marilyn C Lee
- Department of Diabetes and Endocrinology, University College London Hospitals, London, UK.
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12
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Karkar AM, Tang LH, Kashikar ND, Gonen M, Solomon SB, DeMatteo RP, D' Angelica MI, Correa-Gallego C, Jarnagin WR, Fong Y, Getrajdman GI, Allen P, Kingham TP. Management of hepatocellular adenoma: comparison of resection, embolization and observation. HPB (Oxford) 2013; 15:235-43. [PMID: 23374365 PMCID: PMC3572286 DOI: 10.1111/j.1477-2574.2012.00584.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 08/26/2012] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Hepatocellular adenoma (HA) is an uncommon benign hepatic tumour with the potential for malignant change or spontaneous haemorrhage. Resection has been the recommended treatment, but outcomes with other approaches are ill defined. METHODS Demographic and outcomes data were retrospectively collected on patients diagnosed with HA at a tertiary hepatobiliary centre from 1992-2011 whom underwent resection, bland embolization or observation. RESULTS In total, 52 patients with 100 adenomas were divided into single HA (n = 27), multiple HA (n = 18), and adenomatosis (n = 7) groups. Eighty-seven per cent were female and 37% had a history of hormone use. Median sizes of resected, embolized and observed adenomas were 3.6 cm, 2.6 cm and 1.2 cm, respectively. Forty-eight adenomas were resected as a result of suspicion of malignancy (39%) or large size (39%); 61% of these were solitary. Thirty-seven were embolized for suspicion of malignancy (56%) or hsemorrhage (20%); 92% of these were multifocal. Two out of three resected adenomas with malignancy were ≥10 cm and recurred locally [4%, confidence interval (CI) 1-14%]. Ninety-two per cent of the embolized adenomas were effectively treated; three persisted (8.1%, CI 2-22%). Most observed lesions did not change over time. CONCLUSIONS While solitary adenomas are often resected, multifocal HAs are frequently embolized. Small adenomas can safely be observed. Given low recurrence rates, select HAs can be considered for embolization.
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Affiliation(s)
- Ami M. Karkar
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Laura H. Tang
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Nilesh D. Kashikar
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Mithat Gonen
- Department of Pathology, Lenox Hill Hospital, New York, NY, USA
| | - Stephen B. Solomon
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Ronald P. DeMatteo
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | | | - William R. Jarnagin
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Yuman Fong
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Peter Allen
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Abstract
Liver test abnormalities are frequent in adult patients with Turner syndrome, corresponding to various pathophysiological mechanisms. Steatosis, steatofibrosis and steatohepatitis are the most frequently reported lesions, caused by metabolic disorders, which are commonly related to overweight. Marked architectural changes, including nodular regenerative hyperplasia, multiple focal nodular hyperplasia and cirrhosis, found in some patients, are associated with a risk of severe liver-related complications. Architectural changes are often observed and are associated with vascular disorders caused by congenitally abnormal vessels. Finally, small bile duct alterations resembling sclerosing cholangitis occur in several patients. Oestrogen replacement therapy does not cause liver toxicity in patients with Turner syndrome and is not contraindicated in case of elevated liver enzymes. Moreover, in recent studies, oestrogen therapy was reported to improve liver function tests. Because of the wide spectrum of potential liver injuries that may occur in Turner syndrome patients, a regular screening of liver enzymes is recommended for early detection and treatment.
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Bano G, Chong H, Vlahos I. A new long term hepatic complication in survivors of childhood haematological malignancy. Med Hypotheses 2012; 79:663-6. [PMID: 22951417 DOI: 10.1016/j.mehy.2012.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 07/21/2012] [Accepted: 08/03/2012] [Indexed: 12/26/2022]
Abstract
Hepatic abnormalities have been documented in survivors of childhood malignancies and a spectrum of liver diseases has been described in this group The risk factors for liver disease include: hepatic surgery; radiotherapy to field including liver; total body irradiation (TBI); chemotherapy, multiple blood transfusions and use of hematopoietic cell transplantation. We report three cases of hepatic adenomatosis (HA) in young women who had been treated for haematological malignancy as children and had bone marrow transplant. These women were on estrogen and growth hormone replacement. They had mild abnormalities of liver function tests. The diagnosis of HA was made on liver imaging and confirmed by liver biopsy. We also propose a hypothesis for the pathogenesis of hepatic adenomatosis in these patients which vascular damage, estrogen replacement and growth hormone deficiency.
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Affiliation(s)
- G Bano
- Cellular and Molecular Medicine, St. George's University of London, London SW17 0RE, United Kingdom.
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15
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Lin H, van den Esschert J, Liu C, van Gulik TM. Systematic review of hepatocellular adenoma in China and other regions. J Gastroenterol Hepatol 2011; 26:28-35. [PMID: 21175790 DOI: 10.1111/j.1440-1746.2010.06502.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hepatocellular adenoma (HCA) is a benign liver neoplasm with a risk of spontaneous bleeding and malignant transformation. The aim of this review article is to review all the case reports and case series of patients with HCA from 1998 to 2008 in China and other parts of the world in order to compare clinical presentation, surgical management and outcomes. A search for all reports of HCA in the world literature from 1998 to 2008 was performed. A total of 356 patients were identified, including 191 patients from China, 104 from Europe, 46 from North America, and 15 from South-East Asia. A female predominance was not observed in Chinese patients in contrast to the other regions. Acute/chronic abdominal pain was the main clinical presentation in all regions. Twenty patients were diagnosed with coexistent hepatocellular carcinoma (HCC), and hepatitis B virus infection (HBV) was found among six of them. The management of HCA consisted of resection in most cases. The clinical presentation of HCA in China differed from other parts of the world regarding male predominance and a higher incidence of coexistent HCC in China. This might be the result of the birth control policy in China, limited oral contraceptive use, and the higher incidence of HBV.
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Affiliation(s)
- Haoming Lin
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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16
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Liang DM, Chen JY, Zhang Y, Gan P, Lin J, Chen AB. Effects of recombinant human growth hormone on growth of human gastric carcinoma xenograft model in nude mice. World J Gastroenterol 2006; 12:3810-3. [PMID: 16804963 PMCID: PMC4087926 DOI: 10.3748/wjg.v12.i24.3810] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study effects of recombinant human growth hormone (rhGH) on growth of a human gastric carcinoma cell in vivo.
METHODS: Experimental mice were divided into control group, rhGH group, oxaliplatin (L-OHP) group and rhGH+L-OHP group. Cultured human gastric carcinoma cells BGC823 were inoculated into right axilla of nude mice and carcinoma xenograft model was established successfully. Inhibitory rate of xenograft tumor growth was estimated by measuring tumor volume; expression of proliferating cell nuclear antigen (PCNA), Bax and Bcl-2 proteins of xenograft tumor was detected using immunohistochemical S-P method.
RESULTS: Tumor growth inhibitory rate, the positive expression rate of PCNA, Bax and Bcl-2 were 49.3%, 58.2%, 65.2% and 59.2% in rhGH+L-OHP group respectively; 46.6%, 62.5%, 59.7% and 64.7% in L-OHP group; 5.0%, 82.7%, 23.2% and 82.2% in rhGH group and 0, 77.8%, 23.5% and 80.3% in control group. There was significant difference between rhGH+L-OHP group (or L-OHP group ) and control group or rhGH group (P < 0.05), whereas there were no significant differences (P > 0.05) between L-OHP group and rhGH+L-OHP group and between rhGH group and control group.
CONCLUSION: rhGH does not accelerate the proli-feration of human gastric cancer cell in vivo.
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Affiliation(s)
- Dao-Ming Liang
- Department of Emergency Surgery of Second Affiliated Hospital, Kunming Medical College, Yunnan Province, China
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17
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Kibar Y, Sümer F, Yildirim I, Gamsizkan M, Avci A, Dayanç M. Nephrogenic adenoma of the bladder in a girl with Turner's syndrome: an unusual association. Int J Urol 2005; 11:795-7. [PMID: 15379949 DOI: 10.1111/j.1442-2042.2004.00890.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We describe a nephrogenic adenoma of the bladder in a 14-year-old girl with Turner's syndrome. The patient also had a past history of urological surgery for vesicoureteral reflux. In this case, the multifocal lesions were successfully treated by transurethral resection.
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Affiliation(s)
- Yusuf Kibar
- Department of Urology, Gülhane Military Medical Academy, School of Medicine, Ankara, Turkey
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18
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Affiliation(s)
- Adrian Reuben
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
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19
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Chen JY, Liang DM, Gan P, Zhang Y, Lin J. In vitro effects of recombinant human growth hormone on growth of human gastric cancer cell line BGC823 cells. World J Gastroenterol 2004; 10:1132-6. [PMID: 15069712 PMCID: PMC4656347 DOI: 10.3748/wjg.v10.i8.1132] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To study the effects of recombinant human growth hormone (rhGH) on growth of human gastric cancer cell line in vitro.
METHODS: Experiment was divided into control group, rhGH group, oxaliplatin (L-OHP) group and rhGH+L-OHP group. Cell inhibitory rate, cell cycle, cell proliferation index (PI) and DNA inhibitory rate of human gastric cancer line BGC823, at different concentrations of rhGH treatment were studied by cell culture, MTT assay and flow cytometry.
RESULTS: The distinctly accelerated effects of rhGH on multiplication of BGC823 cell line were not found in vitro. There was no statistical significance between rhGH group and control group, or between rhGH+L-OHP group and L-OHP group (P > 0.05). The cell growth curve did not rise. Cell inhibitory rate and cells arrested in G0-G1 phase were obviously increased. Meanwhile, cells in S phase and PI were distinctly decreased and DNA inhibitory rate was obviously increased in rhGH+L-OHP group in comparison with control group and rhGH group, respectively (P < 0.01). Cell inhibitory rate showed an increasing trend and PI showed a decreasing trend in rhGH+L-OHP group compared with L-OHP group.
CONCLUSION: In vitro rhGH does not accelerate the multiplication of human gastric cancer cells. It may increase the therapeutic efficacy when it is used in combination with anticancer drugs.
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Affiliation(s)
- Jia-Yong Chen
- Department of General Surgery of the Second Affiliated Hospital, Kunming Medical College, Kunming 650101, Yunnan Province, China. chenjiayong776@.hotmail.com
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