Giant hepatocellular adenoma presenting with chronic iron deficiency anemia

Hepatic adenomas are benign liver tumors found mostly in young women with a history of oral contraceptive usage. They commonly present with abdominal pain from the tumor mass effect, bleeding, or rupture. We report a case of a young woman with a giant hepatic adenoma presenting with chronic iron deficiency anemia, requiring repeated blood transfusion. The mass was an incidental finding with typical features of a hepatic adenoma. Resection was performed and the hemoglobin remained stable up to the present fourth year of follow-up. This is an unusual presentation for which an association is investigated here. There was no evidence of intra-tumoral bleed but reverse-transcribed real-time PCR revealed higher tumor hepcidin RNA expression. Chronic iron deficiency anemia can be an initial presenting problem in patients with hepatic adenomas. Its cause may be multifactorial but the role of hepcidin-mediated anemia needs further evaluation in future cases.