Hepatocellular adenoma management: call for shared guidelines and multidisciplinary approach

Area of Science:

• Hepatology
• Gastroenterology
• Oncology

Background:

• Hepatocellular adenomas (HCAs) are rare benign liver tumors, primarily affecting women using oral contraceptives.
• Management guidelines suggest surgical resection for adenomas exceeding 5 cm to prevent bleeding and malignant transformation, with exceptions for male patients.
• Recent research has elucidated the heterogeneity of HCAs, identifying four major subtypes: HNF1A-inactivated (H-HCA), inflammatory (IHCA), β-catenin-mutated (β-HCA), and unclassified (UHCA).

Purpose of the Study:

• To review the current understanding of hepatocellular adenoma heterogeneity.
• To discuss the clinical implications of different HCA subtypes, focusing on risks of bleeding and malignant transformation.
• To emphasize the need for multidisciplinary collaboration in managing HCAs.

Main Methods:

• Review of recent scientific literature on hepatocellular adenoma classification and molecular alterations.
• Analysis of immunomarker and molecular data for HCA subtype identification.
• Discussion of the natural history and management strategies for different HCA subtypes.

Main Results:

• Hepatocellular adenomas comprise four main subtypes: H-HCA (30-40%), IHCA (40-50%), β-HCA (10-15%), and UHCA (10%).
• β-catenin mutations, particularly in β-HCA and inflammatory β-HCA (β-IHCA), are associated with an increased risk of malignant transformation.
• TERT promoter mutations are identified as a late event in the malignant progression of β-HCA and β-IHCA.

Conclusions:

• HCA subtypes can be accurately identified using liver tissue immunomarkers, correlating well with molecular findings.
• A deeper understanding of HCA subtypes allows for a more personalized approach to patient management, considering individual risks.
• Effective HCA management necessitates close collaboration between hepatologists, pathologists, radiologists, surgeons, and molecular biologists.