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Yang KL, Rogers D. Imaging of Hepatocellular Adenomas: From Molecular Biology to MRI. CURRENT RADIOLOGY REPORTS 2022. [DOI: 10.1007/s40134-022-00400-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Papamichail M, Pizanias M, Heaton ND, M P, M P, Nd H. Minimizing the risk of small-for-size syndrome after liver surgery. Hepatobiliary Pancreat Dis Int 2022; 21:113-133. [PMID: 34961675 DOI: 10.1016/j.hbpd.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/06/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Primary and secondary liver tumors are not always amenable to resection due to location and size. Inadequate future liver remnant (FLR) may prevent patients from having a curative resection or may result in increased postoperative morbidity and mortality from complications related to small-for-size syndrome (SFSS). DATA SOURCES This comprehensive review analyzed the principles, mechanism and risk factors associated with SFSS and presented current available options in the evaluation of FLR when planning liver surgery. In addition, it provided a detailed description of specific modalities that can be used before, during or after surgery, in order to optimize the conditions for a safe resection and minimize the risk of SFSS. RESULTS Several methods which aim to reduce tumor burden, preserve healthy liver parenchyma, induce hypertrophy of FLR or prevent postoperative complications help minimize the risk of SFSS. CONCLUSIONS With those techniques the indications of radical treatment for patients with liver tumors have significantly expanded. The successful outcome depends on appropriate patient selection, the individualization and modification of interventions and the right timing of surgery.
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Affiliation(s)
- Michail Papamichail
- Department of Hepato-Pancreato-Biliary Surgery, Royal Blackburn Hospital, Blackburn BB2 3HH, UK.
| | - Michail Pizanias
- Department of General Surgery, Whittington Hospital, London N19 5NF, UK
| | - Nigel D Heaton
- Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver Studies, Kings Health Partners at King's College Hospital NHS Trust, London SE5 9RS, UK
| | - Papamichail M
- Department of Hepato-Pancreato-Biliary Surgery, Royal Blackburn Hospital, Blackburn BB2 3HH, UK; Department of General Surgery, Whittington Hospital, London N19 5NF, UK; Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver Studies, Kings Health Partners at King's College Hospital NHS Trust, London SE5 9RS, UK
| | - Pizanias M
- Department of Hepato-Pancreato-Biliary Surgery, Royal Blackburn Hospital, Blackburn BB2 3HH, UK; Department of General Surgery, Whittington Hospital, London N19 5NF, UK; Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver Studies, Kings Health Partners at King's College Hospital NHS Trust, London SE5 9RS, UK
| | - Heaton Nd
- Department of Hepato-Pancreato-Biliary Surgery, Royal Blackburn Hospital, Blackburn BB2 3HH, UK; Department of General Surgery, Whittington Hospital, London N19 5NF, UK; Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver Studies, Kings Health Partners at King's College Hospital NHS Trust, London SE5 9RS, UK
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Gaspar-Figueiredo S, Kefleyesus A, Sempoux C, Uldry E, Halkic N. Focal nodular hyperplasia associated with a giant hepatocellular adenoma: A case report and review of literature. World J Hepatol 2021; 13:1450-1458. [PMID: 34786179 PMCID: PMC8568569 DOI: 10.4254/wjh.v13.i10.1450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/15/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) are well-known benign liver lesions. Surgical treatment is usually chosen for symptomatic patients, lesions more than 5 cm, and uncertainty of diagnosis.
CASE SUMMARY We described the case of a large liver composite tumor in an asymptomatic 34-year-old female under oral contraceptive for 17-years. The imaging work-out described two components in this liver tumor; measuring 6 cm × 6 cm and 14 cm × 12 cm × 6 cm. The multidisciplinary team suggested surgery for this young woman with an unclear HCA diagnosis. She underwent a laparoscopic left liver lobectomy, with an uneventful postoperative course. Final pathological examination confirmed FNH associated with a large HCA. This manuscript aimed to make a literature review of the current management in this particular situation of large simultaneous benign liver tumors.
CONCLUSION The simultaneous presence of benign composite liver tumors is rare. This case highlights the management in a multidisciplinary team setting.
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Affiliation(s)
| | - Amaniel Kefleyesus
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne 1011, Switzerland
| | - Christine Sempoux
- Department of Pathology, Lausanne University Hospital, Lausanne 1011, Switzerland
| | - Emilie Uldry
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne 1011, Switzerland
| | - Nermin Halkic
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne 1011, Switzerland
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From an Incidental Finding to an Emergent Treatment: A Case Report of a Hepatic Adenomatosis and Large Ruptured Hepatic Adenoma. Case Rep Gastrointest Med 2021; 2021:9963440. [PMID: 34239741 PMCID: PMC8238616 DOI: 10.1155/2021/9963440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/11/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction. Hepatic adenoma is an uncommon benign liver tumor presenting as solitary lesions or even rarely as hepatic adenomatosis. Large lesions carry a risk of rupture, hemorrhage, and malignant transformation. This case report aims to increase awareness about risk factors for hepatic adenomas, considering the increasing prevalence of obesity and the widespread use of oral contraceptive pills. Case Presentation. A 20-year-old obese female who was taking oral contraceptive pills for seven years presented to the emergency department with vomiting and abdominal pain caused by gastroenteritis. On imaging, multiple hepatic adenomas, including two lesions 6 and 9 cm in diameter, were incidentally found. During the hospitalization, the patient suddenly developed acute anemia and rupture of the largest lesion, which was promptly treated with arterial embolization. Discussion. Obesity and exposure to hormones are well-known risk factors for hepatic adenomas. The incidence of hepatic adenomas is steadily increasing because of the prevalence of obesity, especially among females. Lifestyle interventions for weight loss and discontinuation of oral contraceptive pills are considered a conservative treatment of hepatic adenomas. Large lesions possess the risk of malignant transformation and rupture and require surgical excision.
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Kim SM, Hwang S, Ahn CS, Kim KH, Moon DB, Ha TY, Song GW, Jung DH, Park GC, Hong SM. Clinicopathological features and post-resection outcomes of hepatocellular adenoma. Ann Hepatobiliary Pancreat Surg 2021; 25:25-33. [PMID: 33649251 PMCID: PMC7952660 DOI: 10.14701/ahbps.2021.25.1.25] [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: 09/24/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 11/28/2022] Open
Abstract
Backgrounds/Aims Hepatocellular adenomas (HCA) are rare benign liver tumors with the potential of malignant transformation and risk of bleeding. We investigated the clinicopathological features and outcomes of HCA in 19 patients who underwent surgical resection. Methods This retrospective observational study included 19 patients who underwent hepatic resection during a 9-year period from 2011 to 2019. Results The incidence of HCA was 0.18% of all hepatic resection cases during the study period. The mean age of the patients was 34.3±9.6 years, and 12 patients (63.2%) were female. Abdominal pain was present as initial clinical manifestation in 5 patients and the other 14 patients had no specific symptoms. HCA was diagnosed in 7 out of 8 patients who underwent liver biopsy. R0 resection was performed in 18 patients (94.7%) and laparoscopic liver resection was performed in 11 patients (57.9%). The mean tumor size was 5.6±3.6 cm and 17 patients had a single tumor. Immunohistochemical analysis of the resected tumor specimens revealed hepatocyte-nuclear-factor-1α mutated HCA in 2 (10.5%), β-catenin-mutated HCA in 2 (10.5%), inflammatory HCA in 12 (63.2%) and unclassified HCA in 3 (15.8%). There were no pathognomonic findings in the preoperative liver imaging studies among these four groups. Currently, all patients are alive with a mean follow-up period of 40.1±26.3 months. One patient showed residual tumors after incomplete resection. Conclusions Surgical resection may be indicated if imaging studies show diagnostic ambiguity, growing tumor or symptomatic mass. Because of the risk of tumor recurrence and malignant transformation, long-term follow-up is necessary.
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Affiliation(s)
- Sung-Min Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Hwang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chul-Soo Ahn
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Hun Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Deok-Bog Moon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Yong Ha
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Won Song
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hwan Jung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gil-Chun Park
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Crawford D, Naidu S, Patel I, Knuttinen G, Alzubaidi S, Oklu R. Bland Embolization of Benign Liver Tumors: Review of the Literature and a Single Center Experience. J Clin Med 2021; 10:jcm10040658. [PMID: 33572120 PMCID: PMC7915444 DOI: 10.3390/jcm10040658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 12/11/2022] Open
Abstract
Transarterial embolization has shown promise as a safe, effective, and less invasive treatment modality for benign liver lesions (hemangioma, focal nodular hyperplasia (FNH), and hepatic adenoma (HA)) with fewer complications compared to surgical intervention. There is no consensus regarding the most appropriate embolization material(s) for the treatment of benign liver tumors. The purpose of this study was to review the current literature regarding the transarterial embolization of benign liver tumors and to share our single center experience. This was a non-blinded, retrospective, single-institution review of the bland embolization of benign liver tumors. Clinical data and imaging before and after embolization were used to evaluate lesion response to transarterial embolization. Twelve patients were included in the study. Five patients with six hemangiomas were treated. Pain was a presenting complaint in all five of these patients. The median change in tumor volume was −12.4% and ranged from −30.1% to +42.3%. One patient with two FNH lesions was treated, and both lesion volumes decreased by more than 50%. Six patients with 10 adenomas were treated. Pain was a presenting complaint in three patients, and five patients had a lesion >5 cm. The median change in tumor volume was −67.0% and ranged from −92.9% to +65.8%. Bland transarterial embolization of liver hemangiomas, FNH, and HA can be an effective and minimally invasive treatment modality to control the size and/or symptoms of these lesions. There is a variable response depending on tumor type and the embolization materials used.
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Affiliation(s)
- Daniel Crawford
- Division of Vascular and Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO 63110, USA;
| | - Sailen Naidu
- Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA; (I.P.); (G.K.); (S.A.); (R.O.)
- Correspondence:
| | - Indravadan Patel
- Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA; (I.P.); (G.K.); (S.A.); (R.O.)
| | - Grace Knuttinen
- Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA; (I.P.); (G.K.); (S.A.); (R.O.)
| | - Sadeer Alzubaidi
- Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA; (I.P.); (G.K.); (S.A.); (R.O.)
| | - Rahmi Oklu
- Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA; (I.P.); (G.K.); (S.A.); (R.O.)
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Rodrigues BT, Mei SLCY, Fox A, Lubel JS, Nicoll AJ. A systematic review on the complications and management of hepatic adenomas: a call for a new approach. Eur J Gastroenterol Hepatol 2020; 32:923-930. [PMID: 32433418 DOI: 10.1097/meg.0000000000001766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Hepatic adenomas are benign hepatic lesions with heterogeneous characteristics. Awareness of complications, including haemorrhage and malignant transformation, has improved alongside a concurrent rise in their detection. Monitoring and management guidelines, however, remain inconsistent. This systematic review analyses the natural history of hepatic adenomas, and existing and novel risk factors associated with haemorrhage and malignant transformation. Results of this systematic review commonly identified male sex, and the beta-catenin histopathological hepatic adenoma subtype, as risk factors for malignant transformation, whilst those associated with haemorrhage included lesion size and number, exophytic nature, and recent hormone use. Overall, females demonstrated higher rates of haemorrhage, whilst males exhibited a higher risk of hepatocellular carcinoma development. This systematic review highlights that tumour size and subtype may not be as characteristically linked with complications as previously thought. We have additionally reported novel risk factors contributing to development of hepatic adenoma-related complications. We conclude by highlighting the risk of taking a conservative approach to seemingly low-risk lesions and suggest revised practice guidelines.
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Affiliation(s)
- Beverly T Rodrigues
- Department of Gastroenterology, Eastern Health.,School of Medicine, Monash University, Eastern Health Clinical School, Monash University
| | | | - Adrian Fox
- Department of Gastroenterology, Eastern Health
| | - John S Lubel
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria 3128, Australia
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Vernuccio F, Ronot M, Dioguardi Burgio M, Cauchy F, Choudhury KR, Dokmak S, Soubrane O, Valla D, Zucman-Rossi J, Paradis V, Vilgrain V. Long-term Evolution of Hepatocellular Adenomas at MRI Follow-up. Radiology 2020; 295:361-372. [PMID: 32181728 DOI: 10.1148/radiol.2020191790] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Hepatocellular adenomas (HCAs) are rare benign liver tumors. Guidelines recommend continued surveillance of patients diagnosed with HCAs, but these guidelines are mainly based on small studies or expert opinion. Purpose To analyze the long-term evolution of HCAs, including solitary and multiple lesions, and to identify predictive features of progression with MRI. Materials and Methods In a retrospective study, patients diagnosed with pathologically proven solitary or multiple HCAs between January 2004 and December 2015 were included; β-catenin-mutated HCAs and HCAs with foci of malignancy were considered to be at risk for progression. MRI examinations were analyzed, and tumor evolution was evaluated by using Response Evaluation Criteria in Solid Tumors, version 1.1. Student t, Mann-Whitney, χ2, Fisher exact, and McNemar tests were used, as appropriate. Results In total, 118 patients (mean age, 40 years ± 10 [standard deviation]; 108 women) were evaluated, including 41 with a solitary HCA (mean age, 40 years ± 14; 36 women) and 77 with multiple HCAs (mean age, 40 years ± 10; 72 women). At a median follow-up of 5 years, 37 of 41 (90%) patients with a solitary HCA and 55 of 77 (71%) patients with multiple HCAs showed stable or regressive disease. After resection of solitary HCAs, new lesions appeared in only two of 29 (7%) patients, both of whom had HCAs at risk of progression. In patients with multiple HCAs, hepatocyte nuclear factor 1α-inactivated HCAs showed a higher rate of progression compared with inflammatory HCAs (11 of 26 [42%] vs seven of 37 [19%], P = .04) despite lower use (28 of 32 patients [88%] vs 45 of 45 patients [100%]; P = .03) and shorter duration (mean, 12.0 years ± 7.5 vs 19.2 years ± 9.2; P = .001) of oral contraceptive intake. Conclusion Long-term MRI follow-up showed that 78% of hepatocellular adenomas had long-term stability or regression. After resection of solitary hepatocellular adenomas, new lesions occurred only in hepatocellular adenomas at risk of progression. Patients with multiple hepatocellular adenomas were more likely to show progressive disease, with hepatic nuclear factor 1α-inactivated hepatocellular adenomas being the most common subtype showing progression. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Federica Vernuccio
- From the University of Paris, Paris, France (F.V., M.R., F.C., O.S., D.V., V.P., V.V.); Departments of Radiology (M.R., M.D.B., V.V.), Liver Transplantation and Hepatobiliary Surgery (F.C., S.D., O.S.), and Hepatology (D.V.), and Pathology Department (V.P.), University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; INSERM, UMR 1149, Paris, France (M.R., F.C., O.S., D.V., M.D.B., V.P., V.V.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (K.R.C.); INSERM, UMR 1162, Génomique Fonctionnelle des Tumeurs Solides, Université Paris Descartes, Université Paris Diderot, Université Paris 13, Labex Immuno-Oncology, Paris, France (J.Z.), Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy (F.V.)
| | - Maxime Ronot
- From the University of Paris, Paris, France (F.V., M.R., F.C., O.S., D.V., V.P., V.V.); Departments of Radiology (M.R., M.D.B., V.V.), Liver Transplantation and Hepatobiliary Surgery (F.C., S.D., O.S.), and Hepatology (D.V.), and Pathology Department (V.P.), University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; INSERM, UMR 1149, Paris, France (M.R., F.C., O.S., D.V., M.D.B., V.P., V.V.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (K.R.C.); INSERM, UMR 1162, Génomique Fonctionnelle des Tumeurs Solides, Université Paris Descartes, Université Paris Diderot, Université Paris 13, Labex Immuno-Oncology, Paris, France (J.Z.), Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy (F.V.)
| | - Marco Dioguardi Burgio
- From the University of Paris, Paris, France (F.V., M.R., F.C., O.S., D.V., V.P., V.V.); Departments of Radiology (M.R., M.D.B., V.V.), Liver Transplantation and Hepatobiliary Surgery (F.C., S.D., O.S.), and Hepatology (D.V.), and Pathology Department (V.P.), University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; INSERM, UMR 1149, Paris, France (M.R., F.C., O.S., D.V., M.D.B., V.P., V.V.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (K.R.C.); INSERM, UMR 1162, Génomique Fonctionnelle des Tumeurs Solides, Université Paris Descartes, Université Paris Diderot, Université Paris 13, Labex Immuno-Oncology, Paris, France (J.Z.), Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy (F.V.)
| | - François Cauchy
- From the University of Paris, Paris, France (F.V., M.R., F.C., O.S., D.V., V.P., V.V.); Departments of Radiology (M.R., M.D.B., V.V.), Liver Transplantation and Hepatobiliary Surgery (F.C., S.D., O.S.), and Hepatology (D.V.), and Pathology Department (V.P.), University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; INSERM, UMR 1149, Paris, France (M.R., F.C., O.S., D.V., M.D.B., V.P., V.V.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (K.R.C.); INSERM, UMR 1162, Génomique Fonctionnelle des Tumeurs Solides, Université Paris Descartes, Université Paris Diderot, Université Paris 13, Labex Immuno-Oncology, Paris, France (J.Z.), Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy (F.V.)
| | - Kingshuk R Choudhury
- From the University of Paris, Paris, France (F.V., M.R., F.C., O.S., D.V., V.P., V.V.); Departments of Radiology (M.R., M.D.B., V.V.), Liver Transplantation and Hepatobiliary Surgery (F.C., S.D., O.S.), and Hepatology (D.V.), and Pathology Department (V.P.), University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; INSERM, UMR 1149, Paris, France (M.R., F.C., O.S., D.V., M.D.B., V.P., V.V.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (K.R.C.); INSERM, UMR 1162, Génomique Fonctionnelle des Tumeurs Solides, Université Paris Descartes, Université Paris Diderot, Université Paris 13, Labex Immuno-Oncology, Paris, France (J.Z.), Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy (F.V.)
| | - Safi Dokmak
- From the University of Paris, Paris, France (F.V., M.R., F.C., O.S., D.V., V.P., V.V.); Departments of Radiology (M.R., M.D.B., V.V.), Liver Transplantation and Hepatobiliary Surgery (F.C., S.D., O.S.), and Hepatology (D.V.), and Pathology Department (V.P.), University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; INSERM, UMR 1149, Paris, France (M.R., F.C., O.S., D.V., M.D.B., V.P., V.V.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (K.R.C.); INSERM, UMR 1162, Génomique Fonctionnelle des Tumeurs Solides, Université Paris Descartes, Université Paris Diderot, Université Paris 13, Labex Immuno-Oncology, Paris, France (J.Z.), Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy (F.V.)
| | - Olivier Soubrane
- From the University of Paris, Paris, France (F.V., M.R., F.C., O.S., D.V., V.P., V.V.); Departments of Radiology (M.R., M.D.B., V.V.), Liver Transplantation and Hepatobiliary Surgery (F.C., S.D., O.S.), and Hepatology (D.V.), and Pathology Department (V.P.), University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; INSERM, UMR 1149, Paris, France (M.R., F.C., O.S., D.V., M.D.B., V.P., V.V.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (K.R.C.); INSERM, UMR 1162, Génomique Fonctionnelle des Tumeurs Solides, Université Paris Descartes, Université Paris Diderot, Université Paris 13, Labex Immuno-Oncology, Paris, France (J.Z.), Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy (F.V.)
| | - Dominique Valla
- From the University of Paris, Paris, France (F.V., M.R., F.C., O.S., D.V., V.P., V.V.); Departments of Radiology (M.R., M.D.B., V.V.), Liver Transplantation and Hepatobiliary Surgery (F.C., S.D., O.S.), and Hepatology (D.V.), and Pathology Department (V.P.), University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; INSERM, UMR 1149, Paris, France (M.R., F.C., O.S., D.V., M.D.B., V.P., V.V.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (K.R.C.); INSERM, UMR 1162, Génomique Fonctionnelle des Tumeurs Solides, Université Paris Descartes, Université Paris Diderot, Université Paris 13, Labex Immuno-Oncology, Paris, France (J.Z.), Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy (F.V.)
| | - Jessica Zucman-Rossi
- From the University of Paris, Paris, France (F.V., M.R., F.C., O.S., D.V., V.P., V.V.); Departments of Radiology (M.R., M.D.B., V.V.), Liver Transplantation and Hepatobiliary Surgery (F.C., S.D., O.S.), and Hepatology (D.V.), and Pathology Department (V.P.), University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; INSERM, UMR 1149, Paris, France (M.R., F.C., O.S., D.V., M.D.B., V.P., V.V.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (K.R.C.); INSERM, UMR 1162, Génomique Fonctionnelle des Tumeurs Solides, Université Paris Descartes, Université Paris Diderot, Université Paris 13, Labex Immuno-Oncology, Paris, France (J.Z.), Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy (F.V.)
| | - Valérie Paradis
- From the University of Paris, Paris, France (F.V., M.R., F.C., O.S., D.V., V.P., V.V.); Departments of Radiology (M.R., M.D.B., V.V.), Liver Transplantation and Hepatobiliary Surgery (F.C., S.D., O.S.), and Hepatology (D.V.), and Pathology Department (V.P.), University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; INSERM, UMR 1149, Paris, France (M.R., F.C., O.S., D.V., M.D.B., V.P., V.V.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (K.R.C.); INSERM, UMR 1162, Génomique Fonctionnelle des Tumeurs Solides, Université Paris Descartes, Université Paris Diderot, Université Paris 13, Labex Immuno-Oncology, Paris, France (J.Z.), Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy (F.V.)
| | - Valérie Vilgrain
- From the University of Paris, Paris, France (F.V., M.R., F.C., O.S., D.V., V.P., V.V.); Departments of Radiology (M.R., M.D.B., V.V.), Liver Transplantation and Hepatobiliary Surgery (F.C., S.D., O.S.), and Hepatology (D.V.), and Pathology Department (V.P.), University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; INSERM, UMR 1149, Paris, France (M.R., F.C., O.S., D.V., M.D.B., V.P., V.V.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (K.R.C.); INSERM, UMR 1162, Génomique Fonctionnelle des Tumeurs Solides, Université Paris Descartes, Université Paris Diderot, Université Paris 13, Labex Immuno-Oncology, Paris, France (J.Z.), Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy (F.V.)
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9
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Nahm CB, Parker N, Gundara JS, Gill AJ, Bhimani N, Samra JS, Hugh TJ. Management of patients with hepatocellular adenoma: a single-institution experience. ANZ J Surg 2020; 90:786-790. [PMID: 31943651 DOI: 10.1111/ans.15648] [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: 09/29/2019] [Revised: 10/29/2019] [Accepted: 12/10/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hepatocellular adenoma (HCA) is a rare benign liver tumour that may cause diagnostic and management dilemmas. This study describes the clinical and histopathological characteristics of patients who were treated for HCA in a tertiary referral hospital over a 17-year period. METHODS A retrospective review was performed of prospectively collected data of all patients treated for HCA within the Northern Upper GI Surgical unit between 2002 and 2018. Immunohistochemical β-catenin expression was evaluated. RESULTS Thirty-two patients had histological or radiologically confirmed HCA. Twenty-eight patients underwent 30 operations and four patients were treated conservatively. The median age of the operative group was 43 years (range 19-83) and most patients were female (95%). The median body mass index was 28.7 (range 20-51), and nine patients (33%) were obese. Seven patients (25%) had multifocal HCA. Evidence of prior bleed or rupture or a perceived risk of either a bleed or malignant change (i.e. tumours ≥50 mm) were the most common indications for resection. There were no perioperative mortalities. Nuclear expression of β-catenin by immunohistochemical staining was negative in all cases and there was no malignancy identified in any of the resected lesions. Two patients required transarterial embolization and two patients required a second liver resection for residual HCA. CONCLUSION HCA is a rare lesion predominantly affecting females. Haemorrhage is seen frequently on imaging studies, occasionally requiring urgent angioembolization and/or surgical intervention. Malignant transformation and immunohistochemical β-catenin expression are uncommon. HCA may be multifocal and residual tumours usually require ongoing surveillance and occasionally further intervention.
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Affiliation(s)
- Christopher B Nahm
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Parker
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Justin S Gundara
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Anthony J Gill
- Cancer Diagnosis and Pathology Group, Kolling Institute, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Nazim Bhimani
- Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Jaswinder S Samra
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Thomas J Hugh
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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10
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Haddouche A, Bellanne-Chantelot C, Rod A, Fournier L, Chiche L, Gautier JF, Timsit J, Laboureau S, Chaillous L, Valero R, Larger E, Jeandidier N, Wilhelm JM, Popelier M, Guillausseau PJ, Thivolet C, Lecomte P, Benhamou PY, Reznik Y. Liver adenomatosis in patients with hepatocyte nuclear factor-1 alpha maturity onset diabetes of the young (HNF1A-MODY): Clinical, radiological and pathological characteristics in a French series. J Diabetes 2020; 12:48-57. [PMID: 31166087 DOI: 10.1111/1753-0407.12959] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/13/2019] [Accepted: 05/30/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Liver adenomatosis (LA) is a rare disease resulting from biallelic inactivation of the hepatocyte nuclear factor-1 alpha (HNF1A) gene, which induces the proliferation of adenoma cells in liver parenchyma. Liver adenomatosis has only been documented in case reports from patients carrying a HNF1A germline mutation. We have evaluated the frequency of LA among a large cohort of patients with HNF1A-maturity onset diabetes of the young (MODY), previously termed "MODY3," and herein describe its clinical, radiological, and pathological characteristics. METHODS In all, 137 HNF1A-MODY subjects from 74 families were screened by liver ultrasonography in 13 centers, and 15 additional cases of LA were later included in the series. Liver adenomatosis was confirmed by liver computed tomography, magnetic resonance imaging (MRI), and/or histopathology. RESULTS Among 137 carriers of an HNF1A mutation, 9 patients (6.5%) from seven families were diagnosed with LA. Diabetes mellitus was present in 87.5% of patients with LA. In 25% of patients, LA was diagnosed due to intra-abdominal or intratumoral bleeding. Liver biochemistry was near normal in all patients. Liver imaging showed adenomas of various sizes and numbers. On MRI, most nodules had the radiological characteristics of steatotic adenomas. Histopathological confirmation of LA was available in 13 cases, and these adenomas were mostly steatotic. Surgery was initially performed in 37.5% of patients, and liver disease progression was observed in 30%. No disease progression was observed in 14 pregnancies. CONCLUSIONS The frequency of LA in a cohort of screened HNF1A-MODY patients and the high incidence of LA progression and/or hemorrhage warrants systematic screening for liver adenomatosis in HNF1A-MODY families.
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Affiliation(s)
- Aini Haddouche
- Department of Endocrinology and Diabetology, Caen University Hospital, Caen, France
| | - Christine Bellanne-Chantelot
- Department of Genetics, Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Anne Rod
- Department of Endocrinology and Diabetology, Caen University Hospital, Caen, France
| | - Luc Fournier
- Department of Radiology, Caen University Hospital, Caen, France
| | - Laurence Chiche
- Department of Hepatobiliary and Pancreatic Surgery, Bordeaux University Hospital, Maison du Haut Lévèque, Bordeaux, France
| | - Jean-Francois Gautier
- Department of Endocrinology and Diabetology, Saint Louis University Hospital, Paris, France
| | - Jose Timsit
- Department of Immunology and Diabetology, Cochin University Hospital, Paris, France
| | - Sandrine Laboureau
- Department of Endocrinology and Diabetology, Angers University Hospital, Angers, France
| | - Lucy Chaillous
- Department of Endocrinology, Hôtel Dieu University Hospital, Nantes, France
| | - Rene Valero
- Department of Nutrition and Metabolic Diseases, La Conception Hospital, Marseille, France
| | - Etienne Larger
- Department of Immunology and Diabetology, Cochin University Hospital, Paris, France
| | - Nathalie Jeandidier
- Department of Endocrinology, Diabetology and Metabolic Diseases, Leriche Pavillon, Civil Hospital, Strasbourg, France
| | | | - Marc Popelier
- Department of Medicine, Pitié-Salpetrière Hospital, Paris, France
| | | | - Charles Thivolet
- Department of Endocrinology and Metabolic Diseases, Debrousse University Hospital, Lyon, France
| | - Pierre Lecomte
- Department of Endocrinology and Diabetology, Bretonneau University Hospital, Tours, France
| | - Pierre-Yves Benhamou
- Department of Diabetology, Endocrinology and Nutrition, Grenoble University Hospital, Grenoble, France
| | - Yves Reznik
- Department of Endocrinology and Diabetology, Caen University Hospital, Caen, France
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11
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Impact of open and minimally invasive resection of symptomatic solid benign liver tumours on symptoms and quality of life: a systematic review. HPB (Oxford) 2019; 21:1119-1130. [PMID: 30926331 DOI: 10.1016/j.hpb.2019.02.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/23/2019] [Accepted: 02/28/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The value of open and minimally invasive liver resection for symptomatic solid benign liver tumours (BLT) such as hepatocellular adenoma, focal nodular hyperplasia and haemangioma is being debated. A systematic review on symptom relief, quality of life (QoL) and surgical outcome after both open and minimally invasive surgery for solid BLT is currently lacking. METHODS A systematic search in PubMed and EMBASE was performed according to the PRISMA guidelines (January 1985-April 2018). Articles reporting pre-and postoperative symptoms or QoL in patients undergoing open or minimally surgery for BLT were evaluated. Methodological quality was assessed using the MINORS tool. RESULTS Forty-two studies were included with 4061 patients undergoing surgery for BLT, 3536 (87%) open and 525 (13%) laparoscopic resections. Randomized and propensity-matched studies were lacking. Symptoms were the indication for resection in 56% of the patients. After a weighted mean of 28.5 months follow-up after surgery, symptoms were relieved in 82% of symptomatic patients. Validated QoL tools were used in eight studies, of which two found significant better QoL scores following laparoscopic compared to open surgery. DISCUSSION Resection of symptomatic BLT seems safe and relieves symptoms in the vast majority of selected patients. Comparative studies are needed before more firm conclusions can be drawn.
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12
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Sinkler MA, Bosley M. Massive hepatic adenoma response to bland embolization: A case study. Radiol Case Rep 2019; 14:48-51. [PMID: 30338010 PMCID: PMC6187088 DOI: 10.1016/j.radcr.2018.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 12/29/2022] Open
Abstract
Hepatic adenomas are rare, benign liver masses of rising incidence in the United States. We present a report of a 22-year-old asymptomatic female with a massive (14.2 × 11.4 cm), centrally located hepatic adenoma. The unique presentation of the adenoma in close proximity to the hepatic vasculature meant the patient was not a candidate for surgical resection. An arterial embolization was used as an alternative approach to initial treatment. Arterial branches supplying the adenoma were identified via computed tomography and embolized with embospheres and coils. The treatment resulted in a large reduction in size and density of the adenoma identified at a 1-month follow-up. The case supports further use of arterial embolization as an initial treatment for large adenomas to improve the outcome of subsequent surgical approaches.
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Affiliation(s)
- Margaret A. Sinkler
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Corresponding author.
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13
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Silva JP, Klooster B, Tsai S, Christians KK, Clarke CN, Mogal H, Clark Gamblin T. Elective Regional Therapy Treatment for Hepatic Adenoma. Ann Surg Oncol 2018; 26:125-130. [DOI: 10.1245/s10434-018-6802-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Indexed: 12/19/2022]
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14
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Vernuccio F, Ronot M, Dioguardi Burgio M, Lebigot J, Allaham W, Aubé C, Brancatelli G, Vilgrain V. Uncommon evolutions and complications of common benign liver lesions. Abdom Radiol (NY) 2018; 43:2075-2096. [PMID: 29260281 DOI: 10.1007/s00261-017-1427-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Frequently encountered on abdominal imaging studies, the majority of common benign liver lesions are asymptomatic, confidently diagnosed by imaging, and do not require further workup, follow-up, or treatment. The increasing use of multimodality liver imaging, has allowed the recognition of uncommon evolutions of common benign liver lesions such as size changes, fibrotic regression, and content and vascularization changes, and their complications such as rupture, hemorrhage, thrombosis, extrinsic compression, and malignancy. The purpose of this pictorial review is to describe and illustrate the incidence and diagnostic features of these uncommon evolutions and complications on cross-sectional imaging, mainly on computed tomography and magnetic resonance imaging, with emphasis on those imaging clues which are helpful in the differential diagnosis or indicate the need for treatment.
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15
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Characterization of hepatocellular adenoma and carcinoma using microRNA profiling and targeted gene sequencing. PLoS One 2018; 13:e0200776. [PMID: 30052636 PMCID: PMC6063411 DOI: 10.1371/journal.pone.0200776] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/03/2018] [Indexed: 02/06/2023] Open
Abstract
Background Hepatocellular adenomas (HCA) are benign liver tumors that may transform into hepatocellular carcinoma (HCC), but the molecular drivers of this transformation remain ill-defined. This study evaluates the molecular changes in HCA and HCC and in comparison to their adjacent non-neoplastic liver. Methods 11 patients with HCA and 10 patients with HCC without underlying hepatitis or cirrhosis were included in this pilot study. Tumor and non-tumor liver tissues were selected for immunohistochemical staining, small RNA sequencing, and targeted gene sequencing. We compared microRNA expressions and mutations between HCA and HCC and non-neoplastic liver. Results HCA were classified as inflammatory (n = 6), steatotic (n = 4), or β-catenin activated (n = 1) subtypes. MicroRNA profile of all 3 HCA subtypes clustered between that of normal liver and HCC in principal component analysis. In both HCA and HCC, miR-200a, miR-429, and miR-490-3p were significantly downregulated compared to normal liver, whereas miR-452, miR-766, and miR-1180 were significantly upregulated. In addition, compared to HCA, HCC had significantly higher expression of members of the chromosome 19 miRNA cluster (C19MC), including miR-515-5p, miR-517a, miR-518b, and miR-520c-3p. Conclusions This study indicates that while there are significant differences in the molecular profile between HCA and HCC, several miRNAs are similarly deregulated in HCA and HCC compared to adjacent normal liver. These results may provide insights into the drivers of hepatocarcinogenesis and warrant further investigations.
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16
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Singh HK, Patkar S, Polnaya AM, Ramadwar M, Goel M. Giant Hepatic Adenoma in a 12-Year-Old Girl. J Gastrointest Cancer 2017; 50:156-159. [PMID: 28865036 DOI: 10.1007/s12029-017-9999-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hemant Kumar Singh
- Department of Gastroenterology and Hepatobiliary Surgical Oncology, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, Maharashtra, 400012, India
| | - Shraddha Patkar
- Department of Gastroenterology and Hepatobiliary Surgical Oncology, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, Maharashtra, 400012, India
| | - A M Polnaya
- Department of Intervention Radiology, Tata Memorial Hospital, Mumbai, 400012, India
| | - Mukta Ramadwar
- Department of Pathology, Tata Memorial Hospital, Mumbai, 400012, India
| | - Mahesh Goel
- Department of Gastroenterology and Hepatobiliary Surgical Oncology, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, Maharashtra, 400012, India.
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17
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Zhao C, Pei SL, Cucchetti A, Tong TJ, Ma YL, Zhong JH, Li LQ. Retracted: Systematic review: benefits and harms of transarterial embolisation for treating hepatocellular adenoma. Aliment Pharmacol Ther 2017; 46:83. [PMID: 28318052 DOI: 10.1111/apt.14044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 02/05/2017] [Accepted: 02/22/2017] [Indexed: 01/27/2023]
Abstract
The above article1 from Alimentary Pharmacology & Therapeutics, published online on 20 March 2017 in Wiley OnlineLibrary (www.onlinelibrary.wiley.com) has been retracted by agreement between the Authors, the Editor-in-Chief, R.E. Pounder, and John Wiley & Sons Ltd. The retraction has been agreed due to the inclusion of data accessible only during peer review for another journal.
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Affiliation(s)
- C Zhao
- Department of Interventional Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - S-L Pei
- Department of Anesthesia, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - A Cucchetti
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - T-J Tong
- Department of Mathematics, Hong Kong Baptist University, Kowloon, Hong Kong
| | - Y-L Ma
- Department of Interventional Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - J-H Zhong
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - L-Q Li
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
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18
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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: 3.4] [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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19
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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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20
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Landi F, De' Angelis N, Scatton O, Vidal X, Ayav A, Muscari F, Dokmak S, Torzilli G, Demartines N, Soubrane O, Cherqui D, Hardwigsen J, Laurent A. Short-term outcomes of laparoscopic vs. open liver resection for hepatocellular adenoma: a multicenter propensity score adjustment analysis by the AFC-HCA-2013 study group. Surg Endosc 2017; 31:4136-4144. [PMID: 28281121 DOI: 10.1007/s00464-017-5466-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/13/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patients with hepatocellular adenomas are, in selected cases, candidates for liver resection, which can be approached via laparoscopy or laparotomy. The present study aimed to investigate the effects of the surgical approach on the postoperative morbidities of both minor and major liver resections. METHODS In this multi-institutional study, all patients who underwent open or laparoscopic hepatectomies for hepatocellular adenomas between 1989 and 2013 in 27 European centers were retrospectively reviewed. A multiple imputation model was constructed to manage missing variables. Comparisons of both the overall rate and the types of complications between open and laparoscopic hepatectomy were performed after propensity score adjustment (via the standardized mortality ratio weighting method) on the factors that influenced the choice of the surgical approach. RESULTS The laparoscopic approach was selected in 208 (38%) of the 533 included patients. There were 194 (93%) women. The median age was 38.9 years. After the application of multiple imputation, 208 patients who underwent laparoscopic operations were compared with 216 patients who underwent laparotomic operations. After adjustment, there were 20 (9.6%) major liver resections in the laparoscopy group and 17 (7.9%) in the open group. The conversion rate was 6.3%. The two surgical approaches exhibited similar postoperative morbidity rates and severities. Laparoscopic resection was associated with significantly less blood loss (93 vs. 196 ml, p < 0.001), a less frequent need for pedicle clamping (21 vs. 40%, p = 0.002), a reduced need for transfusion (8 vs. 24 red blood cells units, p < 0.001), and a shorter hospital stay (5 vs. 7 days, p < 0.001). The mortality was nil. CONCLUSIONS Laparoscopy can achieve short-term outcomes similar to those of open surgery for hepatocellular adenomas and has the additional benefits of a reduced blood loss, need for transfusion, and a shorter hospital stay.
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Affiliation(s)
- Filippo Landi
- Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor University Hospital, Paris Est University, APHP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France
| | - Nicola De' Angelis
- Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor University Hospital, Paris Est University, APHP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France
| | - Olivier Scatton
- Department of Liver Transplantation and HPB Surgery, Pitié-Salpêtrière Hospital, Paris, France
| | - Xavier Vidal
- Department of Clinical Pharmacology, Vall d'Hebron University Hospital, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Ahmet Ayav
- Department of Digestive, Hepato-Biliary, Endocrine Surgery, and Surgical Oncology, Nancy University Hospital, Lorraine University, Lorraine, France
| | - Fabrice Muscari
- Department of Digestive Surgery, Toulouse University Hospital, Toulouse, France
| | - Safi Dokmak
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Guido Torzilli
- Department of General Surgery, Humanitas University and Research Hospital, Milan, Italy
| | - Nicolas Demartines
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Olivier Soubrane
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Daniel Cherqui
- Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France
| | - Jean Hardwigsen
- Department of Surgery, la Timone Hospital, Aix-Marseille University, Marseille, France
| | - Alexis Laurent
- Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor University Hospital, Paris Est University, APHP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France.
- INSERM, UMR 955, Créteil, France.
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21
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Thomeer MG, Broker M, Verheij J, Doukas M, Terkivatan T, Bijdevaate D, De Man RA, Moelker A, IJzermans JN. Hepatocellular adenoma: when and how to treat? Update of current evidence. Therap Adv Gastroenterol 2016; 9:898-912. [PMID: 27803743 PMCID: PMC5076773 DOI: 10.1177/1756283x16663882] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Hepatocellular adenoma (HCA) is a rare, benign liver tumor. Discovery of this tumor is usually as an incidental finding, correlated with the use of oral contraceptives, or pregnancy. Treatment options have focused on conservative management for the straightforward, smaller lesions (<5 cm), with resection preferred for larger lesions (>5 cm) that pose a greater risk of hemorrhage or malignant progression. In recent years, a new molecular subclassification of HCA has been proposed, associated with characteristic morphological features and loss or increased expression of immunohistochemical markers. This subclassification could possibly provide considerable benefits in terms of patient stratification, and the selection of treatment options. In this review we discuss the decision-making processes and associated risk analyses that should be made based on lesion size, and subtype. The usefulness of this subclassification system in terms of the procedures instigated as part of the diagnostic work-up of a suspected HCA will be outlined, and suitable treatment schemes proposed.
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Affiliation(s)
| | - Mirelle Broker
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Joanne Verheij
- Department of Pathology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Michael Doukas
- Department of pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Turkan Terkivatan
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Diederick Bijdevaate
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Robert A. De Man
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Adriaan Moelker
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jan N. IJzermans
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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22
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van Rosmalen BV, Bieze M, Besselink MG, Tanis P, Verheij J, Phoa SS, Busch O, van Gulik TM. Long-term outcomes of resection in patients with symptomatic benign liver tumours. HPB (Oxford) 2016; 18:908-914. [PMID: 27553837 PMCID: PMC5094485 DOI: 10.1016/j.hpb.2016.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/16/2016] [Accepted: 07/23/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Benign liver tumours (e.g., hepatocellular adenoma (HCA), focal nodular hyperplasia (FNH), and haemangioma) are occasionally resected for alleged symptoms, although data on long-term outcomes is lacking. The aim of this cross-sectional study was to assess long-term outcomes of surgical intervention. METHODS Forty patients with benign tumours (HCA 20, FNH 12, giant haemangioma 4, cysts 4) were included. Patients filled in Validated McGill Pain Questionnaires, preoperatively and after a median of 54 months after resection. Outcomes were evaluated using paired sample t-test and (M) ANOVA. RESULTS Relief of symptoms sustained in 30/40 patients, within a follow-up of 54 (24-148) months after resection. VAS scores were reduced from 5.5 preoperatively to 1.6 postoperatively (p < 0.001). Patients with left-sided tumours had higher postoperative Pain Rating Index (PRI), compared to patients with right-sided tumours: 15.3 vs. 5.8 (p = 0.018). If patients could reconsider undergoing surgery, 34/38 would again choose resection. Discomfort at the operative scar was the most common complaint: 8/40 patients, all after open surgery, of whom 3/40 had an incisional hernia. 7/40 patients had a laparoscopic resection. CONCLUSION Resection relieved symptoms in 30/40 patients. The operative scar was a frequent source for remaining postoperative complaints, suggesting an advantage for a laparoscopic approach when feasible.
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Affiliation(s)
- Belle V. van Rosmalen
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands,Belle V. van Rosmalen, Academic Medical Centre Amsterdam, Department of Surgery, IWO A1 Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. Tel: +31 20 5665570. Fax: +31 20 6976621.Academic Medical Centre AmsterdamDepartment of SurgeryIWO A1 Meibergdreef 9Amsterdam1105 AZThe Netherlands
| | - Matthanja Bieze
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | | | - Pieter Tanis
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - Joanne Verheij
- Department of Pathology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Saffire S.K.S. Phoa
- Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Olivier Busch
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - Thomas M. van Gulik
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands,Correspondence: Thomas M. van Gulik, Academic Medical Centre Amsterdam, Department of Surgery, IWO A1 Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. Tel: +31 20 5665570. Fax: +31 20 6976621.Academic Medical Centre AmsterdamDepartment of SurgeryIWO A1 Meibergdreef 9Amsterdam1105 AZThe Netherlands
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23
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Chun YS, Parker RJ, Inampudi S, Ehrenwald E, Batts KP, Burgart LJ, Schumacher CW, Mehling JA, Engstrom BI, Hill MJ, Reddy SK, Sielaff TD. Imaging Surveillance of Hypervascular Liver Lesions in Non-Cirrhotic Patients. J Gastrointest Surg 2016; 20:564-7. [PMID: 26376993 DOI: 10.1007/s11605-015-2942-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 09/08/2015] [Indexed: 01/31/2023]
Abstract
A consensus surveillance protocol is lacking for non-cirrhotic patients with hypervascular liver lesions presumed to represent hepatocellular adenomas. Patients with hypervascular liver lesions <5 cm not meeting criteria for focal nodular hyperplasia or hepatocellular carcinoma underwent surveillance with contrast-enhanced magnetic resonance imaging (MRI) 6, 12, and 24 months after baseline imaging. If lesions remained stable or decreased in size, then surveillance imaging was discontinued. Between 2011 and 2014, 116 patients with hypervascular liver lesions were evaluated. Seventy-nine patients were eligible for the surveillance protocol. Median follow-up was 24 months (range, 1-144 months). One patient (1 %) continued oral contraceptive pill (OCP) use and presented with hemorrhage requiring embolization 5 months after initial diagnosis. Ten patients (13 %) underwent elective embolization or surgical resection for size ≥5 cm. The remaining 68 patients (86 %) continued surveillance without hemorrhage or malignant transformation. Risk factors for requiring intervention during the surveillance period included younger age, larger lesion size, and estrogen use (all p < 0.05). Patients with hepatocellular adenomas <5 cm can safely be observed after discontinuing OCP with serial imaging 6, 12, and 24 months after diagnosis. If lesions remain stable or decrease in size, then longer-term surveillance is unlikely to identify patients at risk for complications.
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Affiliation(s)
- Yun Shin Chun
- Department of Surgery, Virginia Piper Cancer Institute, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN, 55407, USA.
| | - Robin J Parker
- Department of Radiology, Virginia Piper Cancer Institute, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN, 55407, USA
| | - Subbarao Inampudi
- Department of Radiology, Virginia Piper Cancer Institute, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN, 55407, USA
| | - Eduardo Ehrenwald
- Department of Radiology, Virginia Piper Cancer Institute, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN, 55407, USA
| | - Kenneth P Batts
- Department of Pathology, Virginia Piper Cancer Institute, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN, 55407, USA
| | - Lawrence J Burgart
- Department of Pathology, Virginia Piper Cancer Institute, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN, 55407, USA
| | - Clark W Schumacher
- Department of Radiology, Virginia Piper Cancer Institute, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN, 55407, USA
| | - Jason A Mehling
- Department of Radiology, Virginia Piper Cancer Institute, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN, 55407, USA
| | - Bjorn I Engstrom
- Department of Radiology, Virginia Piper Cancer Institute, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN, 55407, USA
| | - Mark J Hill
- Department of Surgery, Virginia Piper Cancer Institute, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN, 55407, USA
| | - Srinevas K Reddy
- Department of Surgery, Virginia Piper Cancer Institute, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN, 55407, USA
| | - Timothy D Sielaff
- Department of Surgery, Virginia Piper Cancer Institute, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN, 55407, USA
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Lee SY, Kingham TP, LaGratta MD, Jessurun J, Cherqui D, Jarnagin WR, Kluger MD. PET-avid hepatocellular adenomas: incidental findings associated with HNF1-α mutated lesions. HPB (Oxford) 2016; 18:41-8. [PMID: 26776850 PMCID: PMC4750225 DOI: 10.1016/j.hpb.2015.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/06/2015] [Accepted: 07/07/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatocellular adenoma (HCA) is the second most common benign liver neoplasm and occurs predominantly in women in their reproductive years. Positron emission tomography (PET) using [18F] fluorodeoxyglucose (FDG) is commonly used in cancer staging, surveillance and evaluation of treatment response. PET-avid HCA are rare and can be falsely interpreted as malignancies. METHODS A retrospective review of four institutions' database was performed to identify the PET-avid HCAs with clinico-pathological correlation. RESULTS Nine patients with histological proven PET-avid HCA was identified. Eight out of 9 patients were female with a median age at diagnosis of 44 years. All patients' tumors with available histological subtyping (8/8) were HNF1-α mutated and had no inflammatory changes; 6 out the 9 lesions had prominent (>50%) steatotic changes. CONCLUSION Hepatocellular adenomas, specifically the HNF1-α subtype, can cause false-positive PET findings when seeking to identify malignancy. Concomitantly, PET-CT may have the potential to identify the HCA histopathologic variant with the lowest malignant and hemorrhagic potential.
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Affiliation(s)
- Ser Yee Lee
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States,Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - T. Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States
| | - Maria D. LaGratta
- New York-Presbyterian Hospital – Weill Cornell Medical Center, Diagnostic Radiology, 1305 York Avenue, New York, NY 10021, United States
| | - Jose Jessurun
- New York Presbyterian Hospital – Weill Cornell Medical College, Surgical Pathology, 525 East 68th Street, New York, NY 10065, United States
| | - Daniel Cherqui
- Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
| | - William R. Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States
| | - Michael D. Kluger
- New York Presbyterian Hospital Columbia Presbyterian Medical Center, Department of Surgery, 161 Fort Washington Avenue 823, New York, NY 10024, United States,Correspondence Michael D. Kluger, New York Presbyterian Hospital Columbia Presbyterian Medical Center, Department of Surgery, 161 Fort Washington Avenue 823, New York, NY 10024, United States.
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25
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Hoffmann K, Unsinn M, Hinz U, Weiss KH, Waldburger N, Longerich T, Radeleff B, Schirmacher P, Büchler MW, Schemmer P. Outcome after a liver resection of benign lesions. HPB (Oxford) 2015; 17:994-1000. [PMID: 26456947 PMCID: PMC4605338 DOI: 10.1111/hpb.12496] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 07/08/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Benign liver tumours represent a challenge in clinical management. There is considerable controversy with respect to the indications for surgery as the evidence for surgical treatment is variable. The aim of this retrospective study was to analyse the indication and outcome after resection of benign, solid liver lesions. METHODS Data of 79 patients, who underwent liver resection between 2001 and 2012, were analysed for demographic and outcome parameters. RESULTS Thirty-eight patients with focal nodular hyperplasia (48%), 23 patients with haemangioma (29%) and 18 patients with hepatocellular adenoma (23%) underwent a hepatic resection. A major hepatic resection was performed in 23 patients (29%) and a minor resection in 56 patients (71%). The post-operative mortality rate was zero and the 30-day morbidity rate 13.9%. After a median follow-up of 64 months, 75 patients (95%) were alive, and no patient had developed recurrent disease. Fifty-four patients (68%) were pre-operatively symptomatic, of which, 87% had complete or partial relief of symptoms after a liver resection. The incidence of symptoms increased with the lesions' size. DISCUSSION The management of benign liver lesions necessitates an individualized therapy within a multidisciplinary, evidence-based, treatment algorithm. Resection of benign liver lesions can be performed safely in well-selected patients without mortality and low post-operative morbidity.
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Affiliation(s)
- Katrin Hoffmann
- Department of General and Transplant Surgery, University Hospital HeidelbergHeidelberg, Germany,Internal Medicine IV, University Hospital HeidelbergHeidelberg, Germany
| | - Michael Unsinn
- Department of General and Transplant Surgery, University Hospital HeidelbergHeidelberg, Germany,Internal Medicine IV, University Hospital HeidelbergHeidelberg, Germany
| | - Ulf Hinz
- Department of General and Transplant Surgery, University Hospital HeidelbergHeidelberg, Germany
| | - Karl Heinz Weiss
- Internal Medicine IV, University Hospital HeidelbergHeidelberg, Germany,Department of Radiology, University Hospital HeidelbergHeidelberg, Germany
| | - Nina Waldburger
- Internal Medicine IV, University Hospital HeidelbergHeidelberg, Germany,Institute of Pathology, University Hospital HeidelbergHeidelberg, Germany
| | - Thomas Longerich
- Internal Medicine IV, University Hospital HeidelbergHeidelberg, Germany,Institute of Pathology, University Hospital HeidelbergHeidelberg, Germany
| | - Boris Radeleff
- Internal Medicine IV, University Hospital HeidelbergHeidelberg, Germany,Liver Cancer Center Heidelberg, University Hospital HeidelbergHeidelberg, Germany
| | - Peter Schirmacher
- Internal Medicine IV, University Hospital HeidelbergHeidelberg, Germany,Institute of Pathology, University Hospital HeidelbergHeidelberg, Germany
| | - Markus W Büchler
- Department of General and Transplant Surgery, University Hospital HeidelbergHeidelberg, Germany,Internal Medicine IV, University Hospital HeidelbergHeidelberg, Germany
| | - Peter Schemmer
- Department of General and Transplant Surgery, University Hospital HeidelbergHeidelberg, Germany,Internal Medicine IV, University Hospital HeidelbergHeidelberg, Germany
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26
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Lee SY, Kingham TP, LaGratta MD, Jessurun J, Cherqui D, Jarnagin WR, Kluger MD. PET-avid hepatocellular adenomas: incidental findings associated with HNF1-α mutated lesions. HPB (Oxford) 2015:n/a-n/a. [PMID: 26472264 DOI: 10.1111/hpb.12489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 07/07/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatocellular adenoma (HCA) is the second most common benign liver neoplasm and occurs predominantly in women in their reproductive years. Positron-emission tomography (PET) using [18F] fluorodeoxyglucose (FDG) is commonly used in cancer staging, surveillance and evaluation of the treatment response. PET-avid HCA is rare and can be falsely interpreted as malignancies. METHODS A retrospective review of four institutions' database was performed to identify the PET-avid HCAs with clinico-pathological correlation. RESULTS Nine patients with histological proven PET-avid HCA was identified. Eight out of nine patients were female with a median age at diagnosis of 44 years. All patients' tumours with available histological subtyping (8/8) were HNF1-α mutated and had no inflammatory changes; six out the nine lesions had prominent (>50%) steatotic changes. CONCLUSION Hepatocellular adenomas, specifically the HNF1-α subtype, can cause false-positive PET findings when seeking to identify malignancy. Concomitantly, PET-CT may have the potential to identify the HCA histopathological variant with the lowest malignant and haemorrhagic potential.
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Affiliation(s)
- Ser Yee Lee
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, New York Presbyterian Hospital Weill-Cornell Medical Center, New York, NY, USA
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria D LaGratta
- Diagnostic Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
| | - Jose Jessurun
- Surgical Pathology, New York Presbyterian Hospital - Weill Cornell Medical College, New York, NY, USA
| | - Daniel Cherqui
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, New York Presbyterian Hospital Weill-Cornell Medical Center, New York, NY, USA
- Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
| | - William R Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael D Kluger
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, New York Presbyterian Hospital Weill-Cornell Medical Center, New York, NY, USA
- Department of Surgery, New York Presbyterian Hospital Columbia Presbyterian Medical Center, New York, NY, USA
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27
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Abstract
Hepatic adenomatosis and hepatocellular adenomas share risk factors and the same pathophysiologic spectrum. The presence in the liver of 10 hepatocellular adenomas defines hepatic adenomatosis. The diagnosis may be established incidentally during a liver radiologic examination in the asymptomatic patient, or after associated right upper quadrant pain, hepatomegaly or liver test abnormalities. Upon the diagnosis of hepatic adenomatosis or either of its life-threatening complications - hemorrhage and progression to hepatocellular carcinoma - consideration should be given to potential medical, radiologic and surgical interventions including: observation (estrogens and androgens withdrawal), resection, transarterial embolization, radiofrequency ablation and liver transplantation. The management of patients with hepatic adenomatosis can be challenging. These patients should be ideally referred to centers with expertise in the management of liver diseases.
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Affiliation(s)
- Claire Meyer
- Dr. Claire Meyer, , Fellow in Gastroenterology, Division of Gastroenterology, Washington University School of Medicine, South Euclid Ave, Box 8124, St. Louis, MO, 63110, Tel 314 454 8141
| | - Mauricio Lisker-Melman
- Dr. Mauricio Lisker-Melman, , Professor of Medicine, Director Hepatology Program, Division of Gastroenterology, Washington University School of Medicine, 660 South Euclid Ave, Box 8124, St. Louis, MO, 63110, Tel 314 454 8141
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29
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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: 5.6] [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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30
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Margonis GA, Ejaz A, Spolverato G, Rastegar N, Anders R, Kamel IR, Pawlik TM. Benign solid tumors of the liver: management in the modern era. J Gastrointest Surg 2015; 19:1157-68. [PMID: 25560181 DOI: 10.1007/s11605-014-2723-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 12/04/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Recently, there has been a growing interest in solid benign liver tumors as the understanding of the pathogenesis and molecular underpinning of these lesions continues to evolve. We herein provide an evidence-based review of benign solid liver tumors with particular emphasis on the diagnosis and management of such tumors. METHODS A search of all available literature on benign hepatic tumors through a search of the MEDLINE/PubMed electronic database was conducted. RESULTS New diagnostic and management protocols for benign liver tumors have emerged, as well as new insights into the molecular pathogenesis. In turn, these data have spawned a number of new studies seeking to correlate molecular, clinicopathological, and clinical outcomes for benign liver tumors. In addition, significant advances in surgical techniques and perioperative care have reduced the morbidity and mortality of liver surgery. Despite current data that supports conservative management for many patients with benign liver tumors, patients with severe preoperative symptomatic disease seem to benefit substantially from surgical treatment based on quality of life data. CONCLUSION Future studies should seek to further advance our understanding of the underlying pathogenesis and natural history of benign liver tumors in order to provide clinicians with evidence-based guidelines to optimize treatment of patients with these lesions.
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Affiliation(s)
- Georgios Antonios Margonis
- Department of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA
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31
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Blanc JF, Frulio N, Chiche L, Bioulac-Sage P, Balabaud C. Hepatocellular adenoma management: advances but still a long way to go. Hepat Oncol 2015; 2:171-180. [PMID: 30190996 DOI: 10.2217/hep.14.41] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hepatocellular adenomas (HCAs) are composed of four molecular subgroups: mutations inactivating the HNF1A gene; the inflammatory phenotype with mutations of different genes leading to STAT3 activation; the activation of β-catenin by mutations in exon 3; among β-HCA, half display both inflammatory and β-catenin-activated phenotypes; and the unclassified tumors. The identification of these subtypes by MRI and immunohistochemistry on tissue is considered as a major criterion to manage patients. Of particular relevance is the identification of the β-catenin-mutated group due to its high risk of malignant transformation. In spite of this progress, the classification has not gained recognition among surgeons. It is hoped that by working as a multidisciplinary team, including surgeons, radiologists, pathologists and molecular biologists, patients will be managed more rationally. In this article, we will present known and new data, well accepted and that which is still controversial. The progress made in the field of HCA in the last 12 years, whether in epidemiology, diagnosis (clinical, pathology, imaging) or management, is related in one way or another to molecular advances.
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Affiliation(s)
- Jean Frédéric Blanc
- Hepato-gastroenterology & Digestive Oncology Unit, CHU Bordeaux, Saint-André Hospital, 1 rue Jean Burguet 33075 Bordeaux, France.,Hepato-gastroenterology & Digestive Oncology Unit, CHU Bordeaux, Saint-André Hospital, 1 rue Jean Burguet 33075 Bordeaux, France
| | - Nora Frulio
- Department of Diagnostic & Interventional Imaging, CHU Bordeaux, Saint André hospital, 1 rue Jean Burguet 33075 Bordeaux, France.,Department of Diagnostic & Interventional Imaging, CHU Bordeaux, Saint André hospital, 1 rue Jean Burguet 33075 Bordeaux, France
| | - Laurence Chiche
- Department of Digestive Surgery, Haut Lévêque Hospital, CHU Bordeaux, Avenue de Magellan 33604 PESSAC cedex, France.,Department of Digestive Surgery, Haut Lévêque Hospital, CHU Bordeaux, Avenue de Magellan 33604 PESSAC cedex, France
| | - Paulette Bioulac-Sage
- Department of Pathology, Pellegrin Hospital, CHU Bordeaux, 33076 Bordeaux, France.,Inserm, UMR-1053, Université de Bordeaux, 33076 Bordeaux, France.,Department of Pathology, Pellegrin Hospital, CHU Bordeaux, 33076 Bordeaux, France.,Inserm, UMR-1053, Université de Bordeaux, 33076 Bordeaux, France
| | - Charles Balabaud
- Inserm, UMR-1053, Université de Bordeaux, 33076 Bordeaux, France.,Inserm, UMR-1053, Université de Bordeaux, 33076 Bordeaux, France
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32
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Siegelman ES, Chauhan A. MR characterization of focal liver lesions: pearls and pitfalls. Magn Reson Imaging Clin N Am 2015; 22:295-313. [PMID: 25086931 DOI: 10.1016/j.mric.2014.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Magnetic resonance (MR) can characterize specific tissue subtypes, thus facilitating focal liver lesion diagnosis. Focal liver lesions that are isointense to hyperintense to liver on T1-weighted images are usually hepatocellular in origin. Chemical shift imaging can narrow the differential diagnosis by detecting the presence of lipid or iron. T2 and heavily T2-weigthed fast spin echo imaging can differentiate solid from nonsolid focal liver lesions. The authors illustrate these MR imaging pearls and the uncommon exceptions (pitfalls). The authors hope that you will find this less traditional contribution to the Magnetic Resonance Clinics of North America helpful in clinical practice.
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Affiliation(s)
- Evan S Siegelman
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 34th and Spruce Streets, 1st Floor Silverstein, Philadelphia, PA 19104-4283, USA.
| | - Anil Chauhan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 34th and Spruce Streets, 1st Floor Silverstein, Philadelphia, PA 19104-4283, USA
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33
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Blanc JF, Frulio N, Chiche L, Sempoux C, Annet L, Hubert C, Gouw ASH, de Jong KP, Bioulac-Sage P, Balabaud C. Hepatocellular adenoma management: call for shared guidelines and multidisciplinary approach. Clin Res Hepatol Gastroenterol 2015; 39:180-7. [PMID: 25434466 DOI: 10.1016/j.clinre.2014.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 09/17/2014] [Accepted: 10/06/2014] [Indexed: 02/07/2023]
Abstract
Hepatocellular adenomas are rare benign nodules developed mainly in women taking oral contraceptives. They are solitary or multiple. Their size is highly variable. 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. There are exceptions particularly in men where it is recommended to remove smaller nodules. Since the beginning of this century, major scientific contributions have unveiled the heterogeneity of the disease. HCA are composed of four major subtypes. HNF1A (coding for hepatocyte nuclear factor 1a) inactivating mutations (H-HCA); inflammatory adenomas (IHCA); the β-catenin-mutated HCAs (β-HCA) and unclassified HCA (UHCA) occurring in 30-40%, 40-50%, 10-15% and 10% of all HCA, respectively. Half of β-HCAs are also inflammatory (β-IHCA). Importantly, β-catenin mutations are associated with a high risk of malignant transformation. HCA subtypes can be identified on liver tissue, including biopsies using specific immunomarkers with a good correspondence with molecular data. Recent data has shown that TERT promoter mutation was a late event in the malignant transformation of β-HCA, β-IHCA. Furthermore, in addition to β-catenin exon 3 mutations, other mutations do exist (exon 7 and 8) with a lower risk of malignant transformation. With these new scientific informations, we have the tools to better know the natural history of the different subtypes, in terms of growth, disappearance, bleeding, malignant transformation and to investigate HCA in diseased livers (vascular diseases, alcoholic cirrhosis). A better knowledge of HCA should lead to a more rational management of HCA. This can be done only if the different subspecialties, including hepatologists, liver pathologists, radiologists and surgeons work altogether in close relationship with molecular biologists. It is a long way to go.
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Affiliation(s)
- Jean Frédéric Blanc
- Service d'hépato-gastroentérologie, hôpital Saint-André, CHU de Bordeaux, Inserm UMR 1053, université de Bordeaux, Bordeaux, France.
| | - Nora Frulio
- Service de radiologie, hôpital Saint-André, CHU de Bordeaux, Bordeaux, France.
| | - Laurence Chiche
- Service hépatobiliaire et pancréatique, maison du Haut-Lévèque, CHU de Bordeaux, 33604 Pessac cedex, France.
| | - Christine Sempoux
- Service d'anatomie pathologique, cliniques universitaires Saint-Luc, université catholique de Louvain, 1200 Brussels, Belgium.
| | - Laurence Annet
- Service de radiologie, cliniques universitaires Saint-Luc, université catholique de Louvain, 1200 Brussels, Belgium.
| | - Catherine Hubert
- Service de chirurgie digestive, cliniques universitaires Saint-Luc, université catholique de Louvain, 1200 Brussels, Belgium.
| | - Annette S H Gouw
- Department of Pathology and Medical Biology, University Medical Center Groningen, 9700 Groningen, The Netherlands.
| | - Koert P de Jong
- Department of Hepato-Pancreato-Biliary Surgery & Liver Transplantation, University Medical Center Groningen, 9700 Groningen, The Netherlands.
| | - Paulette Bioulac-Sage
- Inserm UMR 1053, université de Bordeaux, service de pathologie, hôpital Pellegrin, CHU de Bordeaux, 33075 Bordeaux cedex, France.
| | - Charles Balabaud
- Inserm UMR 1053, université de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France.
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Percutaneous Irreversible Electroporation of a Large Centrally Located Hepatocellular Adenoma in a Woman with a Pregnancy Wish. Cardiovasc Intervent Radiol 2014; 38:1031-5. [DOI: 10.1007/s00270-014-1041-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 11/29/2014] [Indexed: 12/18/2022]
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Abstract
Techniques in liver surgery have improved considerably during the last decades, allowing for liver resections with low morbidity and mortality. Preoperative patient selection, perioperative management, and intraoperative blood-sparing techniques are the cornerstones of modern liver surgery. Multimodal treatment of colorectal liver metastases has expanded the group of patients who are potential candidates for liver resection. Adjunctive techniques, including preoperative portal vein embolization and staged hepatectomy, have facilitated the safe performance of extensive liver resection. This article provides an overview of indications for liver resection and a systematic description of the technical approach to the most commonly performed resections.
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Affiliation(s)
- Christoph W Michalski
- Division of Surgical Oncology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
| | - Kevin G Billingsley
- Division of Surgical Oncology, Department of Surgery, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA.
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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: 0.7] [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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de'Angelis N, Memeo R, Calderaro J, Felli E, Salloum C, Compagnon P, Luciani A, Laurent A, Cherqui D, Azoulay D. Open and laparoscopic resection of hepatocellular adenoma: trends over 23 years at a specialist hepatobiliary unit. HPB (Oxford) 2014; 16:783-8. [PMID: 24852081 PMCID: PMC4159449 DOI: 10.1111/hpb.12257] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 01/27/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatocellular adenoma (HCA) is a rare benign liver epithelial tumour that can require surgery. This retrospective study reports a 23-year experience of open and laparoscopic resections for HCA. METHODS Patients with a histological diagnosis of HCA were included in this analysis. Surgical resection was performed in all symptomatic patients and in those with lesions measuring >5 cm. RESULTS Between 1989 and 2012, 62 patients, 59 of whom were female, underwent surgery for HCA (26 by open surgery and 36 by laparoscopic surgery). Overall, 96.6% of female patients had a history of contraceptive use; 54.8% of patients presented with abdominal pain and 11.2% with haemorrhage; the remaining patients were asymptomatic. Patients who underwent laparoscopy had smaller lesions (mean ± standard deviation diameter: 68.3 ± 35.2 mm versus 91.9 ± 42.5 mm; P = 0.022). Operatively, laparoscopic and open liver resection did not differ except in the number of pedicle clamps, which was significantly lower in the laparoscopic group (27.8% versus 57.7% of patients; P = 0.008). Postoperative variables did not differ between the groups. Mortality was nil. Two surgical specimens were classified as HCA/borderline hepatocellular carcinoma. At the 3-year follow-up, all patients were alive with no recurrence of HCA. CONCLUSIONS Open and laparoscopic liver resections are both safe and feasible approaches for the surgical management of HCA. However, laparoscopic liver resections may be limited by lesion size and location and require advanced surgical skills.
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Affiliation(s)
- Nicola de'Angelis
- Digestive Surgery and Liver Transplant Unit, Henri-Mondor Hospital, Université Paris-EstCréteil, France
| | - Riccardo Memeo
- Digestive Surgery and Liver Transplant Unit, Henri-Mondor Hospital, Université Paris-EstCréteil, France
| | - Julien Calderaro
- Department of Pathology, Henri-Mondor Hospital, Université Paris-EstCréteil, France
| | - Emanuele Felli
- Digestive Surgery and Liver Transplant Unit, Henri-Mondor Hospital, Université Paris-EstCréteil, France
| | - Chady Salloum
- Digestive Surgery and Liver Transplant Unit, Henri-Mondor Hospital, Université Paris-EstCréteil, France
| | - Philippe Compagnon
- Digestive Surgery and Liver Transplant Unit, Henri-Mondor Hospital, Université Paris-EstCréteil, France
| | - Alain Luciani
- Department of Radiology and Medical Imaging, Henri-Mondor Hospital, Université Paris-EstCréteil, France
| | - Alexis Laurent
- Digestive Surgery and Liver Transplant Unit, Henri-Mondor Hospital, Université Paris-EstCréteil, France
| | - Daniel Cherqui
- Hepatobiliary and Pancreatic Surgery and Liver Transplantation Unit, Paul Brousse HospitalParis, France
| | - Daniel Azoulay
- Digestive Surgery and Liver Transplant Unit, Henri-Mondor Hospital, Université Paris-EstCréteil, France,Correspondence, Daniel Azoulay, Digestive and Liver Transplant Surgery Unit, Henri-Mondor Hospital, Université Paris Est, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France. Tel: + 33 1 4981 2348. Fax: + 33 1 4981 2432. E-mail:
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Hepatocellular adenomatosis: what should the term stand for! Clin Res Hepatol Gastroenterol 2014; 38:132-6. [PMID: 24126236 DOI: 10.1016/j.clinre.2013.08.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 08/19/2013] [Indexed: 02/04/2023]
Abstract
In 1985, adenomatosis, a term coined to mean ten or more nodules, was considered as a specific entity different from hepatocellular adenoma (HCA) whether single or multiple. In the 2000s the term has lost its individuality. The great contribution of the classification was to clearly demonstrate that in all hepatocellular subtypes and in particular etiologies such as glycogenosis and male hormone administration, HCA could be solitary, multiple (<10) or multiple (>10: adenomatosis). Management of hepatocellular adenomatosis may not be different from solitary or multiple HCA. To keep its specificity in terms of management and prognosis compared to solitary or multiple HCA, it is necessary to indicate the number of nodules including the combination of three parameters: size, location and subtypes. When the classical armentarium to treat nodules is not possible or too risky, embolization or liver transplantation remains the only therapeutic options.
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Ahn SY, Park SY, Kweon YO, Tak WY, Bae HI, Cho SH. Successful treatment of multiple hepatocellular adenomas with percutaneous radiofrequency ablation. World J Gastroenterol 2013; 19:7480-7486. [PMID: 24259982 PMCID: PMC3831233 DOI: 10.3748/wjg.v19.i42.7480] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/05/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular adenoma (HCA) is one of the important complications of glycogen storage disease type Ia (GSD-Ia) because it can be transformed into hepatocellular carcinoma. Although surgical resection is a standard treatment of choice for solitary HCA, multiple HCAs in GSD-Ia patients present as therapeutic challenges for curative treatment. Therefore, treatment strategy according to malignant potential is important in management of HCAs in GSD-Ia. The authors present a case of histologically proven multiple HCAs without β-catenin mutations occurred in a GSD-Ia patient treated successfully with percutaneous radiofrequency ablation as a minimally invasive therapy.
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