Hepatocellular adenoma
Encyclopedia
Hepatocellular adenoma, also hepatic adenoma, or rarely hepadenoma, is an uncommon benign liver
tumor which is associated with the use of hormonal contraception
with a high estrogen
content. Patients taking higher potency hormones, patients of advanced age, or patients with prolonged duration of use have a significantly increased risk of developing hepatocellular adenomas.
Large hepatic adenomas have a tendency to rupture and bleed massively inside the abdomen.
s with a bubbly vacuolated
cytoplasm
. The hepatocytes are on a regular reticulin scaffold and less or equal to three cell thick.
The histologic diagnosis of hepatic adenomas can be aided by reticulin staining. In hepatic adenomas, the reticulin scaffold is preserved and hepatocytes do not form layers of four or more hepatocytes, as is seen in hepatocellular carcinoma
.
Cells resemble normal hepatocytes and are traversed by blood vessels but lack portal tracts or central veins.
Liver
The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...
tumor which is associated with the use of hormonal contraception
Hormonal contraception
Hormonal contraception refers to birth control methods that act on the endocrine system. Almost all methods are composed of steroid hormones, although in India one selective estrogen receptor modulator is marketed as a contraceptive. The original hormonal method—the combined oral contraceptive...
with a high estrogen
Estrogen
Estrogens , oestrogens , or œstrogens, are a group of compounds named for their importance in the estrous cycle of humans and other animals. They are the primary female sex hormones. Natural estrogens are steroid hormones, while some synthetic ones are non-steroidal...
content. Patients taking higher potency hormones, patients of advanced age, or patients with prolonged duration of use have a significantly increased risk of developing hepatocellular adenomas.
Diagnosis
MRI is the most useful investigation in the diagnosis and work-up. CT may also be used to diagnose hepatic adenomas.Large hepatic adenomas have a tendency to rupture and bleed massively inside the abdomen.
Radiologic differential diagnosis
- Echinococcal cyst
- Focal fatty change
- Focal nodular hyperplasiaFocal nodular hyperplasiaFocal nodular hyperplasia is a benign tumour of the liver , which is the second most prevalent tumour of the liver . It is usually asymptomatic, rarely grows or bleeds, and has no malignant potential...
- HepatoblastomaHepatoblastomaHepatoblastoma is an uncommon malignant liver neoplasm occurring in infants and children and composed of tissue resembling fetal or mature liver cells or bile ducts. Affecting 1 in 1.5 million. They are usually present with an abdominal mass...
- Infiltrative liver disease
- Inflammatory pseudotumor
- LeiomyosarcomaLeiomyosarcomaLeiomyosarcoma , aka LMS, is a malignant cancer of smooth muscle....
- LymphomaLymphomaLymphoma is a cancer in the lymphatic cells of the immune system. Typically, lymphomas present as a solid tumor of lymphoid cells. Treatment might involve chemotherapy and in some cases radiotherapy and/or bone marrow transplantation, and can be curable depending on the histology, type, and stage...
- Nodular regenerative hyperplasiaNodular regenerative hyperplasiaNodular regenerative hyperplasia is a form of liver hyperplasia associated with portal hypertension.It can be a complication of azathioprine therapy....
Pathologic diagnosis
Hepatic adenoma are, typically, well-circumscribed nodules that consist of sheets of hepatocyteHepatocyte
A hepatocyte is a cell of the main tissue of the liver. Hepatocytes make up 70-80% of the liver's cytoplasmic mass.These cells are involved in:* Protein synthesis* Protein storage* Transformation of carbohydrates...
s with a bubbly vacuolated
Vacuole
A vacuole is a membrane-bound organelle which is present in all plant and fungal cells and some protist, animal and bacterial cells. Vacuoles are essentially enclosed compartments which are filled with water containing inorganic and organic molecules including enzymes in solution, though in certain...
cytoplasm
Cytoplasm
The cytoplasm is a small gel-like substance residing between the cell membrane holding all the cell's internal sub-structures , except for the nucleus. All the contents of the cells of prokaryote organisms are contained within the cytoplasm...
. The hepatocytes are on a regular reticulin scaffold and less or equal to three cell thick.
The histologic diagnosis of hepatic adenomas can be aided by reticulin staining. In hepatic adenomas, the reticulin scaffold is preserved and hepatocytes do not form layers of four or more hepatocytes, as is seen in hepatocellular carcinoma
Hepatocellular carcinoma
Hepatocellular carcinoma is the most common type of liver cancer. Most cases of HCC are secondary to either a viral hepatitide infection or cirrhosis .Compared to other cancers, HCC is quite a rare tumor in the United States...
.
Cells resemble normal hepatocytes and are traversed by blood vessels but lack portal tracts or central veins.
Etiology
Ninety percent of hepatic adenomas arise in women aged 20–40, most of whom use oral contraceptives.Related Conditions
Hepatic adenomas are related to glycogen storage diseases, type 1, as well as anabolic steroids.Treatment
Some authors feel that all hepatocellular adenoma should be resected, because of the risk of rupture causing bleeding and because they may contain malignant foci.. However, the majority of experts feel that lesions less than 5 cm should merely be observed with serial imaging. Patients with adenomas should avoid oral contraceptives or hormonal replacement therapy.External links
- http://library.med.utah.edu/WebPath/NEOHTML/NEOPL021.html