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Surgical Management of Hepatocellular Adenoma: Take It or Leave It?

  • Hepatic and Pancreatic Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Hepatocellular adenoma (HA) is a rare benign tumor of the liver. Surgical resection is generally indicated to reduce risks of hemorrhage and malignant transformation. We sought to evaluate clinical presentation, surgical management, and outcomes of patients with HA at our institution.

Methods

We performed a retrospective review of 41 patients who underwent surgical resection for HA between 1988 and 2007.

Results

Thirty-eight patients were women, and the median age at presentation was 36 years (range, 19–65 years). The most common clinical presentation was abdominal pain (70%) followed by incidental radiological finding (17%). Twenty-two patients had a history of oral contraceptive use. Median number of HA was one (range, 1–3). There were 32 open cases (3 trisectionectomy, 15 hemihepatectomy, 7 sectionectomy, 4 segmentectomy, and 3 wedge resection), and 9 laparoscopic cases (1 hemihepatectomy, 5 sectionectomy, 1 segmentectomy, and 2 wedge resection). The median estimated blood loss was 225 mL (range, 0–3400 mL). The median length of stay was 6 days (range, 1–15 days). Surgical morbidities included pleural effusion requiring percutaneous drainage (n = 2), pneumonia (n = 1), and wound infection (n = 1). There was no perioperative mortality. Twelve patients had hemorrhage from HA. Hepatocellular carcinoma was observed in two patients with HA. Median follow-up was 23 months (range, 1–194 months), at which time all patients were alive.

Conclusion

In view of 29% hemorrhagic and 5% malignant complication rates, we recommend surgical resection over observation if patient comorbidities and anatomic location of HA are favorable. A laparoscopic approach can be safely used in selected cases.

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References

  1. Jarnagin WR, Gonen M, Fong Y, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 2002;236:397–406

    Article  PubMed  Google Scholar 

  2. Koffron A, Geller D, Gamblin TC, et al. Laparoscopic liver surgery: shifting the management of liver tumors. Hepatology 2006;44:1694–700

    Article  PubMed  Google Scholar 

  3. Descottes B, Glineur D, Lachachi F, et al. Laparoscopic liver resection of benign liver tumors. Surg Endosc 2003;17:23–30

    Article  PubMed  CAS  Google Scholar 

  4. Paradis V, Laurent A, Flejou JF, et al. Evidence for the polyclonal nature of focal nodular hyperplasia of the liver by the study of X-chromosome inactivation. Hepatology 1997;26:891–5

    Article  PubMed  CAS  Google Scholar 

  5. Rebouissou S, Bioulac-Sage P, Zucman-Rossi J. Molecular pathogenesis of focal nodular hyperplasia and hepatocellular adenoma. J Hepatol 2008;48:163–70

    Article  PubMed  CAS  Google Scholar 

  6. Barthelmes L, Tait IS. Liver cell adenoma and liver cell adenomatosis. HPB 2005;7:186–96

    Article  PubMed  Google Scholar 

  7. Belghiti J, Pateron D, Panis Y, et al. Resection of presumed benign liver tumors. Br J Surg 1993;80:380–3

    Article  PubMed  CAS  Google Scholar 

  8. Closset J, Veys I, Peny MO, et al. Retrospective analysis of 29 patients surgically treated for hepatocellular adenoma or focal nodular hyperplasia. Hepatogastroenterology 2000;47:1382–4

    PubMed  CAS  Google Scholar 

  9. De Carlis L, Pirotta V, Rondinara G, et al. Hepatic adenoma and focal nodular hyperplasia: diagnosis and criteria for treatment. Liver Transpl Surg 1997;3:160–5

    Article  PubMed  Google Scholar 

  10. Erdogan D, Busch ORC, van Delden OM, et al. Management of spontaneous hemorrhage and rupture of hepatocellular adenomas. a single center experience. Liver Int 2006;26:433–8

    Article  PubMed  Google Scholar 

  11. Herman P, Pugliese V, Machado MAC, et al. Hepatic adenoma and focal nodular hyperplasia: differential diagnosis and treatment. World J Surg 2000;24:372–6

    Article  PubMed  CAS  Google Scholar 

  12. Nagorney DM. Benign hepatic tumors: focal nodular hyperplasia and hepatocellular adenoma. World J Surg 1995;19:13–8

    Article  PubMed  CAS  Google Scholar 

  13. Rooks JB, Ory HW, Ishak KG, et al. Epidemiology of hepatocellular adenoma. The role of oral contraceptive use. JAMA 1979;242:644–8

    Article  PubMed  CAS  Google Scholar 

  14. Grazioli L, Federle MP, Brancatelli G, et al. Hepatic adenomas: imaging and pathologic findings. Radiographics 2001;21:877–92

    PubMed  CAS  Google Scholar 

  15. Craig JR, Peters RL, Edmondson HA. Atlas of tumor pathology: tumors of the liver, intrahepatic bile ducts. Fasc 27, ser 2. Armed Forces Institute of Pathology: Washington, DC, 1989:19–41

  16. Ault G, Wren S, Ralls PW, et al. Selective management of hepatic adenomas. Am Surg 1996;62:825–9

    PubMed  CAS  Google Scholar 

  17. Leese T, Farges O, Bismuth H. Liver cell adenomas. A 12-year surgical experience from a specialist hepato-biliary unit. Ann Surg 1988;208:558–64

    Article  PubMed  CAS  Google Scholar 

  18. Marini P, Vilgrain V, Belghiti J. Management of spontaneous rupture of liver tumors. Dig Surg 2002;19:109–13

    Article  PubMed  CAS  Google Scholar 

  19. Tao LC. Oral contraceptive–associated liver cell adenoma and hepatocellular carcinoma. cytomorphology and mechanism of malignant transformation. Cancer 1991;68:341–7

    Article  PubMed  CAS  Google Scholar 

  20. Anderson PH, Packer JT. Hepatic adenoma–observation after estrogen withdrawal. Arch Surg 1976;111:898–900

    Google Scholar 

  21. Aseni P, Sansalone CV, Sammartino C, et al. Rapid disappearance of hepatic adenoma after contraceptive withdrawal. J Clin Gastroenterol 2001;33:234–6

    Article  PubMed  CAS  Google Scholar 

  22. Steinbrecher UP, Lisbona R, Huang SN, et al. Complete regression of hepatocellular adenoma after withdrawal of oral contraceptives. Dig Dis Sci 1981;26:1045–50

    Article  PubMed  CAS  Google Scholar 

  23. Bühler H, Pirovino M, Akobiantz A, et al. Regression of liver cell adenoma. A follow-up study of three consecutive patients after discontinuation of oral contraceptive use. Gastroenterology 1982;82:775–82

    PubMed  Google Scholar 

  24. Edmondson HA, Reynolds TB, Henderson B, et al. Regression of liver cell adenomas associated with oral contraceptives. Ann Intern Med 1977;86:180–2

    PubMed  CAS  Google Scholar 

  25. Ramseur WL, Cooper MR. Asymptomatic liver cell adenomas. another case of resolution after discontinuation of oral contraceptive use. JAMA 1978;239:1647–8

    Article  PubMed  CAS  Google Scholar 

  26. Gordon SC, Reddy KR, Livingstone AS, et al. Resolution of a contraceptive-steroid–induced hepatic adenoma with subsequent evolution into hepatocellular carcinoma. Ann Intern Med 1986;105:547–9

    PubMed  CAS  Google Scholar 

  27. Tesluk H, Lawrie J. Hepatocellular adenoma. its transformation to carcinoma in a user of oral contraceptives. Arch Pathol Lab Med 1981;105:296–9

    PubMed  CAS  Google Scholar 

  28. Marks WH, Thompson N, Appleman H. Failure of hepatic adenomas (HCA) to regress after discontinuance of oral contraceptives. an association with focal nodular hyperplasia (FNH) and uterine leiomyoma. Ann Surg 1988;208:190–5

    Article  PubMed  CAS  Google Scholar 

  29. Foster JH, Berman MM. The malignant transformation of liver cell adenomas. Arch Surg 1994;129:712–7

    PubMed  CAS  Google Scholar 

  30. Bioulac-Sage P, Rebouissou S, Thomas C, et al. Hepatocellular adenoma subtype classification using molecular markers and immunohistochemistry. Hepatology 2007;46:740–8

    Article  PubMed  CAS  Google Scholar 

  31. Chen YW, Jeng YM, Yeh SH, et al. P53 Gene and Wnt signaling in benign neoplasms: beta-catenin mutations in hepatic adenoma but not in focal nodular hyperplasia. Hepatology 2002;36(4 Pt 1):927–35

    PubMed  CAS  Google Scholar 

  32. Wilkens L, Bredt M, Flemming P, et al. Diagnostic impact of fluorescence in situ hybridization in the differentiation of hepatocellular adenoma and well-differentiated hepatocellular carcinoma. J Mol Diagn 2001;3:68–73

    PubMed  CAS  Google Scholar 

  33. Terkivatan T, de Wilt JH, de Man RA, et al. Management of hepatocellular adenoma during pregnancy. Liver 2000;20;186–7

    Article  PubMed  CAS  Google Scholar 

  34. Cobey FC, Salem RR. A review of liver masses in pregnancy and a proposed algorithm for their diagnosis and management. Am J Surg 2004;187:181–91

    Article  PubMed  Google Scholar 

  35. Flowers BF, McBurney RP, Vera SR. Ruptured hepatic adenoma: a spectrum of presentation and treatment. Am Surg 1990;56:380–3

    PubMed  CAS  Google Scholar 

  36. Terkivatan T, de Wilt JH, de Man RA, et al. Indications and long-term outcome of treatment for benign hepatic tumors: a critical appraisal. Arch Surg 2001;136:1033–8

    Article  PubMed  CAS  Google Scholar 

  37. Atwell TD, Brandhagen DJ, Charboneau JW, et al. Successful treatment of hepatocellular adenoma with percutaneous radiofrequency ablation. AJR Am J Roentgenol 2005;184:828–31

    PubMed  Google Scholar 

  38. Ameriks JA, Thompson NW, Frey CF, et al. Hepatic cell adenomas, spontaneous liver rupture and oral contraceptives. Arch Surg 1975;110:548–57

    PubMed  CAS  Google Scholar 

  39. Ardito F, Tayar C, Laurent A, et al. Laparoscopic liver resection for benign disease. Arch Surg 2007;142:1188–93

    Article  PubMed  Google Scholar 

  40. Arrive L, Flejou JF, Vilgrain V, et al. Hepatic adenoma: MR Findings in 51 pathologically proven lesions. Radiology 1994;193:507–12

    PubMed  CAS  Google Scholar 

  41. Charny CK, Janagin WR, Schwartz LH, et al. Management of 155 patients with benign liver tumors. Br J Surg 2001;88:808–13

    Article  PubMed  CAS  Google Scholar 

  42. Cherqui D, Rahmouni A, Charlotte F, et al. Management of focal nodular hyperplasia and hepatocellular adenoma in young women: a series of 41 patients with clinical, radiological, and pathological correlations. Hepatology 1995;22:1674–81

    Article  PubMed  CAS  Google Scholar 

  43. Chung KY, Mayo-Smith WW, Saini S, et al. Hepatocellular adenoma: MR imaging features with pathologic correlation. AJR Am J Roentgenol 1995;165:303–8

    PubMed  CAS  Google Scholar 

  44. Descottes B, Lachachi F, Sodji M, et al. Early experience with laparoscopic approach for solid liver tumors: initial 16 cases. Ann Surg 2000;232:641–5

    Article  PubMed  CAS  Google Scholar 

  45. Gold JH, Guzman IJ, Rosai J. Benign tumors of the liver. Am J Clin Pathol 1978;70:6–17

    PubMed  CAS  Google Scholar 

  46. Golli M, van Nhieu JT, Mathieu D, et al. A hepatocellular adenoma: color Doppler US and pathologic correlations. Radiology 1994;190:741–4

    PubMed  CAS  Google Scholar 

  47. Hung CH, Changchien CS, Lu SN, et al. Sonographic features of hepatic adenomas with pathologic correlation. Abdom Imaging 2001;26;500–6

    Article  PubMed  CAS  Google Scholar 

  48. Ichikawa T, Federle MP, Grazioli L, et al. Hepatocellular adenoma: multiphasic CT and histopathologic findings in 25 patients. Radiology 2000;214:861–8

    PubMed  CAS  Google Scholar 

  49. Katkhouda N, Hurwitz M, Gugenheim J, et al. Laparoscopic management of benign solid and cystic lesions of the liver. Ann Surg 1999;229:460–6

    Article  PubMed  CAS  Google Scholar 

  50. Kim J, Ahmad SA, Lowy AM, et al. An algorithm for the accurate identification of benign liver lesions. Am J Surg 2004;187:274–9

    Article  PubMed  Google Scholar 

  51. Kerlin P, Davis L, McGill DB, et al. Hepatic adenoma and focal nodular hyperplasia: clinical, pathologic, and radiologic features. Gastroenterology 1983;84(5 Pt 1):994–1002

    PubMed  CAS  Google Scholar 

  52. Labrune P, Trioche P, Duvaltier I, et al. Hepatocellular adenomas in glycogen storage disease type I and III: a series of 43 patients and review of the literature. J Pediatr Gastroenterol Nutr 1997;24:276–9

    Article  PubMed  CAS  Google Scholar 

  53. Mathieu D, Bruneton JN, Drouillard J, et al. Hepatic adenomas and focal nodular hyperplasia: dynamic CT study. Radiology 1986;160:53–8

    PubMed  CAS  Google Scholar 

  54. Neuberger J, Portmann B, Nunnerley HB, et al. Oral-contraceptive–associated liver tumors: occurrence of malignancy and difficulties in diagnosis. Lancet 1980;1:273–6

    Article  PubMed  CAS  Google Scholar 

  55. Paulson EK, McClellan JS, Washington K, et al. Hepatic adenoma: MR characterisitics and correlation with pathologic findings. AJR Am J Roentgenol 1994;163:113–6

    PubMed  CAS  Google Scholar 

  56. Reddy KR, Kligerman S, Levi J, et al. Benign and solid tumors of the liver: relationship to sex, age, size of tumors, and outcome. Am Surg 2001;67:173–8

    PubMed  CAS  Google Scholar 

  57. Reddy SK, Kishnani PS, Sullivan JA, et al. Resection of hepatocellular adenoma in patients with glycogen storage disease type Ia. J Hepatol 2007;47:658–63

    Article  PubMed  CAS  Google Scholar 

  58. Toso C, Majno P, Andres A, et al. Management of hepatocellular adenoma: solitary-uncomplicated, multiple and ruptured tumors. World J Gastroenterol 2005;11:5691–5

    PubMed  Google Scholar 

  59. Van der Windt DJ, Kok NFM, Hussain SM, et al. Case-orientated approach to the manaagement of hepatocellular adenoma. Br J Surg 2006;93:1495–502

    Article  PubMed  Google Scholar 

  60. Weil R 3rd, Koep LJ, Starzl T. Liver resection for hepatic adenoma. Arch Surg 1979;114:178–80

    PubMed  Google Scholar 

  61. Weimann A, Ringe B, Klempnauer J, et al. Benign liver tumors: differential diagnosis and indications for surgery. World J Surg 1997;21:983–90

    Article  PubMed  CAS  Google Scholar 

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Acknowledgment

Supported by grant NIH K12 HD 049109 (T.C.G.).

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Authors and Affiliations

  1. Division of Transplantation, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA

    Sung W. Cho MBBS, MSc, J. Wallis Marsh MD, Jennifer Steel PhD, David A. Geller MD & T. Clark Gamblin MD, MS

  2. Department of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA, 15213, USA

    Shane E. Holloway MD

  3. Division of Surgical Oncology, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA

    Jason T. Heckman MD & T. Clark Gamblin MD, MS

  4. Department of Pathology, University of Pittsburgh, Pittsburgh, PA , 15213, USA

    Erin R. Ochoa MD

  5. UPMC Liver Cancer Center, 3459 Fifth Avenue MUH 7S, Pittsburgh, PA, 15213, USA

    T. Clark Gamblin MD, MS

Authors
  1. Sung W. Cho MBBS, MSc
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  2. J. Wallis Marsh MD
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  3. Jennifer Steel PhD
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  4. Shane E. Holloway MD
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  6. Erin R. Ochoa MD
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  7. David A. Geller MD
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  8. T. Clark Gamblin MD, MS
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Corresponding author

Correspondence to T. Clark Gamblin MD, MS.

Additional information

Presented at Society of Surgical Oncology 61st Annual Cancer Symposium, Chicago, Illinois, March 13–16, 2008.

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Cho, S.W., Marsh, J.W., Steel, J. et al. Surgical Management of Hepatocellular Adenoma: Take It or Leave It?. Ann Surg Oncol 15, 2795–2803 (2008). https://doi.org/10.1245/s10434-008-0090-0

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