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Management of patients with hepatocellular adenoma: a single-institution experience
Christopher B Nahm1,2, Nicholas Parker1, Justin S Gundara1
1Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Insights
Hepatocellular adenoma (HCA) is a rare liver tumor primarily affecting women. While bleeding is common, malignant transformation and specific protein expression are rare, often requiring surveillance or intervention.
Area of Science:
- Hepatology
- Gastroenterology
- Surgical Oncology
Background:
- Hepatocellular adenoma (HCA) represents a rare benign liver tumor.
- It presents significant diagnostic and management challenges.
Purpose of the Study:
- To describe the clinical and histopathological features of patients treated for HCA.
- To analyze management strategies and outcomes over a 17-year period.
Main Methods:
- Retrospective review of prospectively collected data from 2002-2018.
- Inclusion of patients treated for HCA in a tertiary referral hospital.
- Evaluation of immunohistochemical β-catenin expression.
Main Results:
- 32 patients confirmed with HCA; 28 underwent surgery.
- Female predominance (95%), median age 43 years, 33% obese.
- No malignancy or β-catenin expression found; bleeding/rupture risk and tumor size >50mm were resection indications.
Conclusions:
- HCA predominantly affects females and can present with hemorrhage.
- Malignant transformation and β-catenin expression are uncommon.
- Multifocal HCA may necessitate surveillance and further intervention.
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.
