Patients may be asymptomatic or may have non-specific complaints if the disease is not complicated, such as abdominal pain that is diffuse or located in the liver projection area or they might notice a palpable mass [1].

Tumor rupture leads to hemoperitoneum, with various degrees of blood loss, leading to severe abdominal pain accompanied by thirst, tachycardia, hypotension, diaphoresis, signs of hypovolemic shock. If left untreated, this complication causes death.

Jaundice appears if the biliary duct is compressed by the tumor, and this happens more often if several hepatocellular adenomas coexist. Some patients may present with pallor and asthenia, symptoms of chronic anemia. If malignant transformation occurs, symptoms resemble those of hepatocellular carcinoma [2], such as weight loss, pruritus, encephalopathy symptoms, splenomegaly, variceal bleeding, increasing abdominal girth due to ascites.

• Splenomegaly

  If malignant transformation occurs, symptoms resemble those of hepatocellular carcinoma, such as weight loss, pruritus, encephalopathy symptoms, splenomegaly, variceal bleeding, increasing abdominal girth due to ascites. [symptoma.com]

• Weakness

  Danazol, an inhibitor of pituitary gonadotropin with weak androgenic effect, is currently being used for the treatment of endometriosis. [ncbi.nlm.nih.gov]

  “Mutations in the exons 7 and 8 of the CTNNB1 gene can also occur, leading to weak beta-catenin activation and patchy GS staining in most cases,” he says. [captodayonline.com]

  Cytoplasmic staining was assessed for SAA, and staining was scored as none or weak only, patchy (≤50%) strong staining, or diffuse (>50%) strong staining. [academic.oup.com]

  GS IHC was scored as 0 (negative, or weak perivascular staining in 10 % of the tumor), and 2+ (diffuse strong staining), as previously described [ 19 ]. [diagnosticpathology.biomedcentral.com]

• Anemia

  Chronic iron deficiency anemia can be an initial presenting problem in patients with hepatic adenomas. Its cause may be multifactorial but the role of hepcidin-mediated anemia needs further evaluation in future cases. [ncbi.nlm.nih.gov]

  Some patients may present with pallor and asthenia, symptoms of chronic anemia. [symptoma.com]

  Anemia and increased transaminases were more often associated to ruptured HA, while increased alkaline phosphatase and γ-glutamyl transpeptidase to solitary-uncomplicated and multiple HA (Table 2 ). [doi.org]

  Anemia and increased transaminases were more often associated to ruptured HA, while increased alkaline phosphatase and g -glutamyl transpeptidase to solitary-uncomplicated and multiple HA (Table 2). [web.archive.org]

• Weight Loss

  Four (40%) females showed significant weight loss. In resected patients, weight loss allowed stability (n = 1) or slight regression (n = 1) of residual HCA. [ncbi.nlm.nih.gov]

  If malignant transformation occurs, symptoms resemble those of hepatocellular carcinoma, such as weight loss, pruritus, encephalopathy symptoms, splenomegaly, variceal bleeding, increasing abdominal girth due to ascites. [symptoma.com]

  If that’s the case, patients should look out for a few more serious indications, which include: Unexpected weight loss Gastrointestinal issues Jaundice Abdominal pain and swelling Fatigue In conjunction with oral contraceptive use, hormone replacement [liverandpancreassurgeon.com]

  Symptoms that prompt discovery include recent to chronic abdominal pain or discomfort, palpable mass, and constitutional symptoms such as weight loss, weakness, and fever (3,4). [path.upmc.edu]

• Amyloidosis

  We report a case of a woman who showed hepatic and renal AA amyloidosis with a liver adenoma associated with the use of oral contraceptives. [ncbi.nlm.nih.gov]

  Positive controls were included in each run, including kidney with amyloidosis for SAA, HCC for GS, and colorectal adenocarcinoma for β-catenin. Cirrhotic liver was included in each run as a negative control for GS. [academic.oup.com]

• Swelling

  If that’s the case, patients should look out for a few more serious indications, which include: Unexpected weight loss Gastrointestinal issues Jaundice Abdominal pain and swelling Fatigue In conjunction with oral contraceptive use, hormone replacement [liverandpancreassurgeon.com]

• Aspiration

  Classic histology techniques performed on a needle aspiration specimen may be non-diagnostic (usually showing normal hepatocytes with abnormal lobular arrangement or peliosis hepatis), but immunohistochemistry may be useful: glutamine synthetase staining [symptoma.com]

  Only fine needle aspiration is advised for biopsy, because of the risk of hemorrhage with adenoma. Focal nodular hyperplasia takes up radionuclide, stains intensely on angiography, and is safe to biopsy percutaneously. [ncbi.nlm.nih.gov]

  Cytology was performed by fine needle puncture-aspiration (FPA) of the nodules. The cytological samples did not reveal any malignancy. Subsequently, the patient was subjected to magnetic resonance imaging (MRI). [bjsm.bmj.com]

• Abdominal Pain

  pain with peritoneal signs or fluid wave sign. [symptoma.com]

  Twenty-nine months after the initial presentation, the patient was admitted with acute upper abdominal pain and abdominal tenderness. [ncbi.nlm.nih.gov]

• Nausea

  […] oral contraceptives and anabolic steroids Hepatic hemangioma : possible hormonal component ; estrogen therapy associated with increased growth in size Symptoms/clinical findings Usually asymptomatic Large tumors → upper abdominal pain, fullness, and nausea [amboss.com]

  Symptoms are more likely if they are > 4 cm; symptoms include discomfort, fullness, and, less often, anorexia, nausea, early satiety, and pain secondary to bleeding or thrombosis. These tumors often have a characteristic highly vascular appearance. [msdmanuals.com]

  Sometimes it causes mild symptoms, though, such as pain, nausea, or a full feeling. This typically occurs when the tumor is large enough to put pressure on neighboring organs and tissues. [healthline.com]

  Solitary-uncomplicated HA Multiple HA Ruptured HA Total Cases ( n ) 9 6 10 25 No. of HA 1 9 >39 2 10 >58 Symptoms (no. of cases) None 3 3 0 6 Pain 6 3 10 19 Nausea/vomiting 3 0 5 8 Diarrhea 0 0 2 2 Asthenia 1 1 0 2 Median duration of symptoms (wk) 3 8 [doi.org]

• Acute Abdomen

  abdomen and new material on CT and MR angiography, lung cancer screening, pulmonary embolism, coronary artery calcium screening, and interventional CT techniques including radiofrequency ablation and CT fluoroscopy. [books.google.com]

  We present here a unique case of strangulated adenoma of the liver presenting as acute abdomen. [ncbi.nlm.nih.gov]

• Severe Abdominal Pain

  abdominal pain with peritoneal signs or fluid wave sign. [symptoma.com]

  I was rushed to hospital with severe abdominal pain and a bloated stomach. They performed an emergency embolisation (they cut off the blood supply to the tumour). [steadyhealth.com]

• Tachycardia

  Tumor rupture leads to hemoperitoneum, with various degrees of blood loss, leading to severe abdominal pain accompanied by thirst, tachycardia, hypotension, diaphoresis, signs of hypovolemic shock. If left untreated, this complication causes death. [symptoma.com]

  If not treated, there is a 30% risk of bleeding. [3] Bleeding may lead to hypotension, tachycardia, and sweating ( diaphoresis ). [ edit ] Hepatic adenomas are related to glycogen storage diseases, type 1, as well as anabolic steroid use. [en.wikipedia.org]

• Liver Mass

  We have recently encountered a 53-year-old man who had a liver mass in a non-cirrhotic liver, and the liver mass was compatible with HA on the pre-operative computed tomography. [ncbi.nlm.nih.gov]

  Liver Calcifications and Calcified Liver Masses: Pattern Recognition Approach on CT
Madhavi Patnana et al
AJR 2018; 211:76–86 “The second most common subtype is the HNF-1α-mutated hepatocellular adenoma (30–35% of cases). [ctisus.com]

• Sweating

  […] adenocarcinoma - Renal cell carcinoma - Multiple endocrine neoplasia - Endometrioid tumor - Apudoma - Klatskin tumor - Carcinoid - Cylindroma Adrenocortical adenoma / Adrenocortical carcinoma Papillary hidradenoma Adnexal And Skin appendage (8390-8429) sweat [wikidoc.org]

  If not treated, there is a 30% risk of bleeding. [3] Bleeding may lead to hypotension, tachycardia, and sweating ( diaphoresis ). [ edit ] Hepatic adenomas are related to glycogen storage diseases, type 1, as well as anabolic steroid use. [en.wikipedia.org]

• Pruritus

  If malignant transformation occurs, symptoms resemble those of hepatocellular carcinoma, such as weight loss, pruritus, encephalopathy symptoms, splenomegaly, variceal bleeding, increasing abdominal girth due to ascites. [symptoma.com]

• Asthenia

  Some patients may present with pallor and asthenia, symptoms of chronic anemia. [symptoma.com]

  The patient displayed asthenia and anorexia of 1 month duration. [bjsm.bmj.com]

  Solitary-uncomplicated HA Multiple HA Ruptured HA Total Cases ( n ) 9 6 10 25 No. of HA 1 9 >39 2 10 >58 Symptoms (no. of cases) None 3 3 0 6 Pain 6 3 10 19 Nausea/vomiting 3 0 5 8 Diarrhea 0 0 2 2 Asthenia 1 1 0 2 Median duration of symptoms (wk) 3 8 [doi.org]

  Table 1 Clinical presentation of different forms of HA Solitary-uncomplicated HA Multiple HA Ruptured HA Total Cases ( n ) 9 6 10 25 No. of HA 1 9 >39 2 10 >58 Symptoms (no. of cases) None 3 3 0 6 Pain 6 3 10 19 Nausea/vomiting 3 0 5 8 Diarrhea 0 0 2 2 Asthenia [web.archive.org]

• Encephalopathy

  If malignant transformation occurs, symptoms resemble those of hepatocellular carcinoma, such as weight loss, pruritus, encephalopathy symptoms, splenomegaly, variceal bleeding, increasing abdominal girth due to ascites. [symptoma.com]

  Recherchez par intervenant Thèmes ADDICTOLOGIE ALCOOL ASCITE CHC CHOLANGIOCARCINOME CHOLANGITE BILIAIRE PRIMITIVE CHOLANGITE SCLÉROSANTE CHOLESTASE CIRRHOSE COVID DIABETE ENCEPHALOPATHIE HEPATIQUE FIBROSE FOIE BIOARTIFICIEL FOIE ET CHIRURGIE FOIE ET GROSSESSE [afef.asso.fr]

Clinical examination should look for direct tumor symptoms (right hypochondrium mass or hepatomegaly), acute or chronic bleeding signs (tachycardia, orthostatic or permanent hypotension, pallor), compression signs (jaundice) and indications for tumor rupture: severe abdominal pain with peritoneal signs or fluid wave sign.

Blood workup should include the determination of aspartate aminotransferase, alanine aminotransferase (likely to be elevated due to the compression exerted by the tumor on the rest of the hepatocytes), gamma-glutamyl transferase and alkaline phosphatase, that might also be mildly elevated, complete blood cell count and inflammatory markers such as C-reactive protein and serum amyloid A that might also be high, alpha-fetoprotein that should be normal (if abnormal, consider carcinoma), carcinoembryonic antigen (if high, consider colon metastasis) and entamoeba histolytica and echinococcus granulosus tests.

Abdominal ultrasonography describes a well delineated, hypoechoic mass with venous flow patterns, better described by contrast-enhanced echography [3]. Computer tomography (CT) and magnetic resonance imaging (MRI) scans may describe necrosis and calcification.

Classic histology techniques performed on a needle aspiration specimen may be non-diagnostic (usually showing normal hepatocytes with abnormal lobular arrangement or peliosis hepatis), but immunohistochemistry may be useful: glutamine synthetase staining [4], E-cadherin, matrix metalloproteinases 1, 2, 7 and 9 [5], agrin and CD 34 [6], glycipan-3 [7] and cytokeratin 7 and 9 [8] may be valuable markers. Still, percutaneous biopsy of a presumed hepatocellular adenoma should not be routinely performed, as it might induce bleeding and dissemination. Immunohistochemical techniques can also be applied to excised masses if there is doubt about their nature.

Tc99m sulfur colloid scans show a photopenic center with a high uptake rim or a homogenous high uptake lesion [9]. Angiographic studies describe a well-irrigated periphery, different from the pattern seen in focal nodular hyperplasia [10].

• Entamoeba Histolytica

  histolytica and echinococcus granulosus tests. [symptoma.com]

• Hepatocellular Carcinoma

  […] adenoma and hepatocellular carcinoma. [ncbi.nlm.nih.gov]

  Hussain SM, Semelka RC, Mitchell DG (2002) MR imaging of hepatocellular carcinoma. Magn Reson Imaging Clin N Am 10:31–52, v PubMed CrossRef Google Scholar 14. [dx.doi.org]

• Liver Biopsy

  KEYWORDS: Differential diagnosis; Focal nodular hyperplasia; Hepatocellular adenoma; Hepatocellular carcinoma; Liver biopsy [ncbi.nlm.nih.gov]

  Romil Saxena presents interpretation of liver biopsies according to a pattern-based approach that begins with recognition of the predominant histological pattern of injury, followed by identification of secondary features and appropriate work-up that [books.google.com]

  The use of liver biopsy, therapeutic options and follow-up are decided by the presentation of the lesion and associated patient characteristics. [ijhpd.com]

This case report suggests that the indication for IRE may extend to the treatment of benign liver tumors that cannot be treated safely otherwise. [ncbi.nlm.nih.gov]

The prognosis is not well established yet and malignant transformation has been recently associated with β-catenin activation. [ncbi.nlm.nih.gov]

Prognosis Malignant transformation is rare and the long-term prognosis is good. The documents contained in this web site are presented for information purposes only. [orpha.net]

Their appearance and prognosis are different from other subtypes. They are the second most common (30-35%) hepatic adenoma, after the inflammatory subtype. They occur only in female patients, most with a history of oral contraceptive (OCP) use. [radiopaedia.org]

The etiological factors of HCA are known to relate to the contraceptive pill usage in female and the anabolic-androgenic-steroid administration in male. [ncbi.nlm.nih.gov]

Etiology In most cases, adenomas develop for unclear reasons in an otherwise healthy liver. [orpha.net]

Epidemiology Frequency: hepatic hemangioma (most common) > focal nodular hyperplasia ( FNH ) > hepatocellular adenoma (rare) Sex: ♀ > ♂ (∼ 6:1) Age: can appear at any age, but mostly affects young women Most often an incidental finding on imaging tests Etiology [amboss.com]

Abstract This educational review focuses on the epidemiology and radiological evaluation of the various subtypes of hepatic adenomas (HCAs). [ncbi.nlm.nih.gov]

"Epidemiology of hepatocellular adenoma. The role of oral contraceptive use". JAMA. 242 (7): 644–8. doi : 10.1001/jama.242.7.644. PMID 221698. ^ a b c d "Hepatocellular Adenoma: eMedicine Gastroenterology". ^ a b c Anthony S. [en.wikipedia.org]

Anthony P (2002) Tumours and tumour-like lesions of the liver and biliary tract: aetiology, epidemiology and pathology. In: MacSween RNM BA, Portmann BC (eds) Pathology of the liver. Churchill Livingstone, pp 711–775 Google Scholar 11. [dx.doi.org]

Herein, we review how molecular classification has modified our understanding of the pathophysiology and risk factors of HCA development, analysing its impact on clinical care in the field of diagnosis and therapeutic stratification. [ncbi.nlm.nih.gov]

Jump to: navigation, search Adenoma Microchapters Home Patient Information Overview Classification Pathophysiology Causes Differentiating Adenoma from other Diseases Epidemiology & Demographics Risk Factors Screening Natural History, Complications & Prognosis [wikidoc.org]

[…] contraceptive pills, approximately 3 per 100,000 ( N Engl J Med 1976;294:470 ) Additional risk factors include anabolic steroids, noncontraceptive estrogen supplements, obesity and metabolic syndrome Mean age = 37 - 41 years Rare in pediatric patients Pathophysiology [pathologyoutlines.com]

Although the pathophysiology is not yet fully known, malignant transformation of HA into hepatocellular carcinoma (HCC) has been reported [ 8 - 10 ]. [kjim.org]

There is no consensus in the literature for their management except that once their size exceeds 5 cm nodules are taken out to prevent 2 major complications: bleeding and malignant transformation. [ncbi.nlm.nih.gov]

Secondary Prevention Cost-Effectiveness of Therapy Future or Investigational Therapies Case Studies Case #1 Adenoma historical perspective On the Web Most recent articles Most cited articles Review articles CME Programs Powerpoint slides Images American [wikidoc.org]

When doctors discover a large adenoma, they may recommend that it be surgically removed to prevent that possibility. [liverfoundation.org]

1. Dokmak S, Paradis V, Vilgrain V, et al. A single-center surgical experience of 122 patients with single and multiple hepatocellular adenomas. Gastroenterology. 2009;137:1698–1705.
2. Bioulac-Sage P, Taouji S, Possenti L, Balabaud C. Hepatocellular adenoma subtypes: the impact of overweight and obesity. Liver Int. 2012;32:1217–1221.
3. van den Esschert JW, van Gulik TM, Phoa SS. Imaging modalities for focal nodular hyperplasia and hepatocellular adenoma. Dig Surg. 2010. 27(1):46-55.
4. Hechtman JF, Raoufi M, Fiel MI, et al. Hepatocellular carcinoma arising in a pigmented telangiectatic adenoma with nuclear ß-catenin and glutamine synthetase positivity: case report and review of the literature. Am J Surg Pathol. 2011 Jun. 35(6):927-32
5. Tretiakova MS, Hart J, Shabani-Rad MT, Zhang J, Gao ZH. Distinction of hepatocellular adenoma from hepatocellular carcinoma with and without cirrhosis using E-cadherin and matrix metalloproteinase immunohistochemistry. Mod Pathol. 2009 Aug. 22(8):1113-20.
6. Tatrai P, Somoracz A, Batmunkh E, et al. Agrin and CD34 immunohistochemistry for the discrimination of benign versus malignant hepatocellular lesions. Am J Surg Pathol. 2009 Jun. 33(6):874-85.
7. Wang HL, Anatelli F, Zhai QJ, et al. Glypican-3 as a useful diagnostic marker that distinguishes hepatocellular carcinoma from benign hepatocellular mass lesions. Arch Pathol Lab Med. 2008 Nov. 132(11):1723-8.
8. Ahmad I, Iyer A, Marginean CE, et al. Diagnostic use of cytokeratins, CD34, and neuronal cell adhesion molecule staining in focal nodular hyperplasia and hepatic adenoma. Hum Pathol. 2009 May. 40(5):726-34.
9. Lubbers PR, Ros PR, Goodman ZD, et al. Accumulation of technetium-99m sulfur colloid by hepatocellular adenoma: scintigraphic-pathologic correlation. AJR Am J Roentgenol. 1987;148 (6): 1105-8.
10. Grazioli L, Federle MP, Brancatelli G, Ichikawa T, Olivetti L, Blachar A. Hepatic adenomas: imaging and pathologic findings. Radiographics. 2001;21:877–892; discussion 892-894.