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Kahraman G, Haberal KM, Dilek ON. Imaging features and management of focal liver lesions. World J Radiol 2024; 16:139-167. [PMID: 38983841 PMCID: PMC11229941 DOI: 10.4329/wjr.v16.i6.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/28/2024] [Accepted: 05/22/2024] [Indexed: 06/26/2024] Open
Abstract
Notably, the number of incidentally detected focal liver lesions (FLLs) has increased dramatically in recent years due to the increased use of radiological imaging. The diagnosis of FLLs can be made through a well-documented medical history, physical examination, laboratory tests, and appropriate imaging methods. Although benign FLLs are more common than malignant ones in adults, even in patients with primary malignancy, accurate diagnosis of incidental FLLs is of utmost clinical significance. In clinical practice, FLLs are frequently evaluated non-invasively using ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Although US is a cost-effective and widely used imaging method, its diagnostic specificity and sensitivity for FLL characterization are limited. FLLs are primarily characterized by obtaining enhancement patterns through dynamic contrast-enhanced CT and MRI. MRI is a problem-solving method with high specificity and sensitivity, commonly used for the evaluation of FLLs that cannot be characterized by US or CT. Recent technical advancements in MRI, along with the use of hepatobiliary-specific MRI contrast agents, have significantly improved the success of FLL characterization and reduced unnecessary biopsies. The American College of Radiology (ACR) appropriateness criteria are evidence-based recommendations intended to assist clinicians in selecting the optimal imaging or treatment option for their patients. ACR Appropriateness Criteria Liver Lesion-Initial Characterization guideline provides recommendations for the imaging methods that should be used for the characterization of incidentally detected FLLs in various clinical scenarios. The American College of Gastroenterology (ACG) Clinical Guideline offers evidence-based recommendations for both the diagnosis and management of FLL. American Association for the Study of Liver Diseases (AASLD) Practice Guidance provides an approach to the diagnosis and management of patients with hepatocellular carcinoma. In this article, FLLs are reviewed with a comprehensive analysis of ACR Appropriateness Criteria, ACG Clinical Guideline, AASLD Practice Guidance, and current medical literature from peer-reviewed journals. The article includes a discussion of imaging methods used for the assessment of FLL, current recommended imaging techniques, innovations in liver imaging, contrast agents, imaging features of common nonmetastatic benign and malignant FLL, as well as current management recommendations.
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Affiliation(s)
- Gökhan Kahraman
- Department of Radiology, Suluova State Hospital, Amasya 05500, Türkiye
| | - Kemal Murat Haberal
- Department of Radiology, Başkent University Faculty of Medicine, Ankara 06490, Türkiye
| | - Osman Nuri Dilek
- Department of Surgery, İzmir Katip Celebi University, School of Medicine, İzmir 35150, Türkiye
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2
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Aziz H, Underwood PW, Gosse MD, Afyouni S, Kamel I, Pawlik TM. Hepatic adenoma: evolution of a more individualized treatment approach. J Gastrointest Surg 2024; 28:975-982. [PMID: 38521190 DOI: 10.1016/j.gassur.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/07/2024] [Accepted: 03/09/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Hepatic adenomas (HAs) are benign, solid liver lesions, which carry a risk of hemorrhage and malignant transformation. This review article highlights the advances in the diagnosis and management of HAs. METHODS A comprehensive review was performed using MEDLINE/PubMed and Web of Science databases with a search period ending on September 30, 2023. Using PubMed, the terms "hepatocellular," "hepatic," and "adenoma" were searched. RESULTS HA has been classified into at least 8 subtypes based on molecular pathology, each exhibiting unique histopathologic features, clinical considerations, and risk of malignant transformation. The most common subtype is inflammatory HA, followed by hepatocyte nuclear factor 1α-inactivated HA, β-catenin exon 3-mutated HA (βex3-HA), β-catenin exon 7- or 8-mutated HA, sonic hedgehog HA, and unclassified HA. Magnetic resonance imaging is the best imaging method for diagnosis and can distinguish among HA subtypes based on fat and telangiectasia pathologic characteristics. The risk of malignant transformation varies among molecular subtypes, ranging from <1% to approximately 50%. Up to 42% of HAs present with spontaneous intratumoral hemorrhage and peritoneal hemorrhage. In general, only 15% to 20% of patients require surgery. HA larger than 5 cm are more likely to be complicated by bleeding and malignant transformation, regardless of subtype, and should generally be resected. In particular, βex3-HA carries a high risk of malignant transformation and can be considered a true precancerous lesion. CONCLUSION The management of HAs is based on a multidisciplinary approach. Clinical decision-making should integrate information on gender, tumor size, and HA subtyping. In the future, patients with HA will benefit from novel medical therapies tailored to the individual molecular subtypes.
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Affiliation(s)
- Hassan Aziz
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
| | - Patrick W Underwood
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Matthew D Gosse
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
| | - Shadi Afyouni
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Ihab Kamel
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States.
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3
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Zhang Z, Ji J, Qiu G, Hou Z, Mi S, Jin Z, Dai Y, Xie Q, Zeng Y, Huang J. Surgical indications for solid hepatic benign tumors: An updated literature review. Biosci Trends 2023; 17:325-334. [PMID: 37599079 DOI: 10.5582/bst.2023.01152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Hepatic hemangioma, focal nodular hyperplasia, and hepatic adenoma are the most common benign solid liver tumors. However, their surgical indications have been the subject of debate. Minimally invasive liver resection reduces the cost of surgery and may lead to overtreatment of benign liver tumors. Recently, there has been a growing understanding of the etiology, pathogenesis, and natural history of these tumors. Great progress has also been made in imaging. The use of MRI and contrast agents has improved the accuracy of non-invasive diagnosis of these tumors, and especially in the identification of specific molecular subtypes of liver adenoma. These factors have resulted in alterations of surgical indications for these tumors. This article examines recent literature and it discusses the surgical indications for hepatic hemangioma, focal nodular hyperplasia, and hepatic adenoma while summarizing modifications in clinical management.
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Affiliation(s)
- Zhihong Zhang
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jun Ji
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Guoteng Qiu
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ziqi Hou
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Shizheng Mi
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhaoxing Jin
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yunlong Dai
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qingyun Xie
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Zeng
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jiwei Huang
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
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4
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Tse JR, Felker ER, Naini BV, Shen L, Shen J, Lu DSK, Kamaya A, Raman SS. Hepatocellular Adenomas: Molecular Basis and Multimodality Imaging Update. Radiographics 2023; 43:e220134. [PMID: 36821508 DOI: 10.1148/rg.220134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Hepatocellular adenomas (HCAs) are a family of liver tumors that are associated with variable prognoses. Since the initial description of these tumors, the classification of HCAs has expanded and now includes eight distinct genotypic subtypes based on molecular analysis findings. These genotypic subtypes have unique derangements in their cellular biologic makeup that determine their clinical course and may allow noninvasive identification of certain subtypes. Multiphasic MRI performed with hepatobiliary contrast agents remains the best method to noninvasively detect, characterize, and monitor HCAs. HCAs are generally hypointense during the hepatobiliary phase; the β-catenin-mutated exon 3 subtype and up to a third of inflammatory HCAs are the exception to this characterization. It is important to understand the appearances of HCAs beyond their depictions at MRI, as these tumors are typically identified with other imaging modalities first. The two most feared related complications are bleeding and malignant transformation to hepatocellular carcinoma, although the risk of these complications depends on tumor size, subtype, and clinical factors. Elective surgical resection is recommended for HCAs that are persistently larger than 5 cm, adenomas of any size in men, and all β-catenin-mutated exon 3 HCAs. Thermal ablation and transarterial embolization are potential alternatives to surgical resection. In the acute setting of a ruptured HCA, patients typically undergo transarterial embolization with or without delayed surgical resection. This update on HCAs includes a review of radiologic-pathologic correlations by subtype and imaging modality, related complications, and management recommendations. © RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Justin R Tse
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Ely R Felker
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Bita V Naini
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Luyao Shen
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Jody Shen
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - David S K Lu
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Aya Kamaya
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Steven S Raman
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
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Nault JC, Paradis V, Ronot M, Zucman-Rossi J. Benign liver tumours: understanding molecular physiology to adapt clinical management. Nat Rev Gastroenterol Hepatol 2022; 19:703-716. [PMID: 35835851 DOI: 10.1038/s41575-022-00643-5] [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] [Accepted: 06/01/2022] [Indexed: 12/08/2022]
Abstract
Improvements in understanding the pathophysiology of the different benign liver nodules have refined their nosological classification. New criteria have been identified using imaging, histology and molecular analyses for a precise diagnosis of these tumours. Improvement in the classification of liver tumours provides a more accurate prediction of disease progression and has modified patient management. Haemangioma and focal nodular hyperplasia, the most common benign liver tumours that develop in the absence of chronic liver disease, are usually easy to diagnose on imaging and do not require specific treatment. However, hepatocellular adenomas and cirrhotic macronodules can be difficult to discriminate from hepatocellular carcinoma. The molecular subtyping of hepatocellular adenomas in five major subgroups defined by HNF1A inactivation, β-catenin mutation in exon 3 or exon 7/8, and activation of inflammatory or Hedgehog pathways helps to identify the tumours at risk of malignant transformation or bleeding. New clinical, biological and molecular tools have gradually been included in diagnostic and treatment algorithms to classify benign liver tumours and improve patient management. This Review aims to explain the main pathogenic mechanisms of benign liver tumours and how this knowledge could influence clinical practice.
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Affiliation(s)
- Jean-Charles Nault
- Service d'hépatologie, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France. .,Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris Nord, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France. .,Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris Cité, team «Functional Genomics of Solid Tumors», Paris, France. .,Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, Paris, France.
| | - Valérie Paradis
- Service de Pathologie, Hôpital Beaujon, AP-HP Nord, Clichy, France.,Université de Paris, INSERM U1149 "Centre de Recherche sur l'inflammation", CRI, Paris, France
| | - Maxime Ronot
- Université de Paris, INSERM U1149 "Centre de Recherche sur l'inflammation", CRI, Paris, France.,Department of Radiology, Assistance-Publique Hôpitaux de Paris, Hôpital Beaujon, AP-HP Nord, Clichy, France
| | - Jessica Zucman-Rossi
- Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris Cité, team «Functional Genomics of Solid Tumors», Paris, France. .,Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, Paris, France. .,Hôpital Européen Georges Pompidou, APHP, Paris, France.
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6
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Laimer G, Schullian P, Scharll Y, Putzer D, Eberle G, Oberhuber G, Bale R. Stereotactic radiofrequency ablation as a valid first-line treatment option for hepatocellular adenomas. Int J Hyperthermia 2022; 39:780-787. [PMID: 35654476 DOI: 10.1080/02656736.2022.2082562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES This study aimed to assess the safety and efficacy of stereotactic radiofrequency ablation (SRFA) in patients with hepatocellular adenomas (HCA). METHODS Retrospective analyses of all patients referred for SRFA treatment at our institution between January 2010 and October 2020 revealed 14 patients (10 women; mean age 34.4 [range, 17-73 years]) with 38 HCAs treated through 18 ablation sessions. Ablations were considered successful if a safety margin >5 mm was achieved. Demographic, interventional, and outcome data were collected and analyzed. Primary and secondary technical efficacy rates were assessed based on follow-up images consisting of contrast-enhanced CT or MR scans. RESULTS The mean tumor size was 22 mm (range, 7-75 mm). Overall, 37/38 (97.4%) tumors were successfully ablated at the initial SRFA (primary efficacy rate of 97.4%). The median follow-up duration was 49.6 months. No deaths or adenoma-related complications (hemorrhage or malignant transformation) were observed. Disease-free survival rates at 1, 3, and 5 years from the date of the first SRFA were 100%, 85.8%, and 85.8%, respectively. Two patients developed new distant tumors retreated with consecutive re-ablation. No major complications occurred during any of the 18 ablation sessions. CONCLUSIONS Percutaneous thermal ablation is efficient in the treatment of HCAs and may thus be considered a valid first-line treatment option. In addition, SRFA allows for an effective, minimally invasive treatment of large and multiple hepatic tumors within one session.
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Affiliation(s)
- Gregor Laimer
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Peter Schullian
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Yannick Scharll
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Daniel Putzer
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Gernot Eberle
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Georg Oberhuber
- INNPATH, Institute of Pathology, Tirol Kliniken Innsbruck, Innsbruck, Austria
| | - Reto Bale
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
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7
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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: 0.7] [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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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: 1] [Impact Index Per Article: 0.3] [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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10
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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: 0.3] [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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11
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Klompenhouwer AJ, de Man RA, Dioguardi Burgio M, Vilgrain V, Zucman‐Rossi J, Ijzermans JNM. New insights in the management of Hepatocellular Adenoma. Liver Int 2020; 40:1529-1537. [PMID: 32464711 PMCID: PMC7383747 DOI: 10.1111/liv.14547] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/30/2020] [Accepted: 05/21/2020] [Indexed: 12/12/2022]
Abstract
Hepatocellular adenoma (HCA) are benign liver tumours that may be complicated by haemorrhage or malignant transformation to hepatocellular carcinoma. Epidemiological data are fairly outdated, but it is likely to assume that the incidence has increased over the past decades as HCA are more often incidentally found due to the more widespread use of imaging techniques and the increased incidence of obesity. Various molecular subgroups have been described. Each of these molecular subgroups are defined by specific gene mutations and pathway activations. Additionally, they are all related to specific risk factors and show a various biological behaviour. These molecular subgroups may be identified using immunohistochemistry and molecular characterization. Contrast-enhanced MRI is the recommended imaging modality to analyse patients with suspected hepatocellular adenoma allowing to determine the subtype in up to 80%. Surgical resection remains to be the golden standard in treating HCA, although resection is deemed unnecessary in a large number of cases, as studies have shown that the majority of HCA will regress over time without complications such as haemorrhage or malignant transformation occurring. It is preferable to treat patients with suspected HCA in high volume centres with combined expertise of liver surgeons, hepatologists, radiologists and (molecular) pathologists.
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Affiliation(s)
| | - Robert A. de Man
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamthe Netherlands
| | - Marco Dioguardi Burgio
- Department of RadiologyHauts‐de‐SeineUniversity Hospitals Paris Nord Val de SeineBeaujon, APHPClichyFrance,Centre de Recherche sur l'inflammation (CRI)INSERM U1149et Université de ParisParisFrance
| | - Valerie Vilgrain
- Department of RadiologyHauts‐de‐SeineUniversity Hospitals Paris Nord Val de SeineBeaujon, APHPClichyFrance,Centre de Recherche sur l'inflammation (CRI)INSERM U1149et Université de ParisParisFrance
| | - Jessica Zucman‐Rossi
- Centre de Recherche des CordeliersSorbonne Université, INSERMUniversité de ParisParisFrance,Oncology DepartmentAPHPHôpital européen Georges PompidouParisFrance
| | - Jan N. M. Ijzermans
- Department of SurgeryErasmus MC University Medical CenterRotterdamthe Netherlands
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12
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Krause K, Tanabe KK. A Shifting Paradigm in Diagnosis and Management of Hepatic Adenoma. Ann Surg Oncol 2020; 27:3330-3338. [PMID: 32542565 DOI: 10.1245/s10434-020-08580-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND New insights into molecular pathogenesis of hepatocellular adenomas (HCA) have allowed sub-classification based on distinct genetic alterations and a fresh look at characterizations of natural history. Clinically, this is important in understanding risk factors for two feared complications: malignant transformation and hemorrhage. METHODS PubMed literature search for hepatocellular adenoma over all years, excluding case reports and articles focusing on multiple adenomas or adenomatosis. RESULTS The β-catenin exon 3 mutated HCA accounts for about 10% of all HCAs and is associated with the highest risk of malignant transformation. The HF1α subtype accounts for 30-40% of all HCAs and has the lowest risk of malignant transformation. Gender has also emerged as an increasingly important risk factor and males with HCA are at considerably higher risk of malignant transformation, regardless of tumor size. The increasing use of gadoxetic-enhanced MRI has allowed for improved differentiation of HCAs from focal nodular hyperplasia, as well as the identification of specific radiologic features of some subtypes, particularly the inflammatory and HF1α HCAs. CONCLUSIONS Classification of HCA by subtype has important implications for patient counseling and treatment given variable risks of malignant transformation and hemorrhage. Males and those with β-catenin exon 3 mutated HCAs are two groups who should always be counselled to undergo surgical resection. On the other hand, in the lower risk HF1α subtype observation is appropriate in lesions < 5 cm and may even be considered in larger lesions as longer follow-up data is aggregated and tumorigenesis is better understood.
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Affiliation(s)
- Kate Krause
- Division of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kenneth K Tanabe
- Division of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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13
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Carnevale A, Pellegrino F, Cossu A, Ierardi AM, Parenti GC, Carrafiello G, Giganti M. Current concepts in ablative procedures for primary benign liver lesions: a step forward to minimize the invasiveness of treatment when deemed necessary. Med Oncol 2020; 37:31. [PMID: 32193648 PMCID: PMC7102179 DOI: 10.1007/s12032-020-01355-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/28/2020] [Indexed: 12/31/2022]
Abstract
With increased use of medical imaging, the incidental detection of benign solid liver tumors has become more frequent. Facing with benign disease, the indications for surgery are still object of discussion in light of the stable natural course of most lesions and obvious drawbacks of any surgical intervention; therefore, in most situations, a conservative approach is recommended, and surgery is mainly reserved for those cases with persistent or worsening symptoms, or who are at risk for complications as malignant transformation. The advent of ablative techniques has widened the range of treatment options available to these patients, presenting as a valid alternative to resection in terms of safety and efficacy in selected cases, particularly in patients who are considered poor surgical candidates and with smaller lesions. This review outlines the role of percutaneous ablative methods for benign solid liver tumors that are encountered in adults, providing a per histology analysis of the existing evidence. The up-to-date strategies for management of the most common benign solid tumors are recapitulated.
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Affiliation(s)
- Aldo Carnevale
- University Radiology Unit, Radiology Department, Arcispedale Sant'Anna, Via A. Moro 8, Ferrara, 44123, Italy
| | - Fabio Pellegrino
- Department of Morphology, Surgery and Experimental Medicine, Radiology Section, University of Ferrara, Via L. Ariosto 35, Ferrara, 44121, Italy
| | - Alberto Cossu
- University Radiology Unit, Radiology Department, Arcispedale Sant'Anna, Via A. Moro 8, Ferrara, 44123, Italy
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo E Carlo, San Paolo Hospital, University of Milan, Via A di Rudinì 8, Milan, 20142, Italy
| | - Gian Carlo Parenti
- Department of Diagnostic Imaging of Romagna, Ospedale Civile Santa Maria Delle Croci, Ravenna, 48100, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo E Carlo, San Paolo Hospital, University of Milan, Via A di Rudinì 8, Milan, 20142, Italy
| | - Melchiore Giganti
- Department of Morphology, Surgery and Experimental Medicine, Radiology Section, University of Ferrara, Via L. Ariosto 35, Ferrara, 44121, Italy.
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14
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van Rosmalen BV, Klompenhouwer AJ, de Graeff JJ, Haring MPD, de Meijer VE, Rifai L, Dokmak S, Rawashdeh A, Abu Hilal M, de Jong MC, Dejong CHC, Doukas M, de Man RA, IJzermans JNM, van Delden OM, Verheij J, van Gulik TM. Safety and efficacy of transarterial embolization of hepatocellular adenomas. Br J Surg 2019; 106:1362-1371. [PMID: 31313827 PMCID: PMC6771810 DOI: 10.1002/bjs.11213] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/26/2019] [Accepted: 03/25/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatocellular adenoma (HCA) larger than 5 cm in diameter has an increased risk of haemorrhage and malignant transformation, and is considered an indication for resection. As an alternative to resection, transarterial embolization (TAE) may play a role in prevention of complications of HCA, but its safety and efficacy are largely unknown. The aim of this study was to assess outcomes and postembolization effects of selective TAE in the management of HCA. METHODS This retrospective, multicentre cohort study included patients aged at least 18 years, diagnosed with HCA and treated with TAE. Patient characteristics, 30-day complications, tumour size before and after TAE, symptoms before and after TAE, and need for secondary interventions were analysed. RESULTS Overall, 59 patients with a median age of 33.5 years were included from six centres; 57 of the 59 patients were women. Median tumour size at time of TAE was 76 mm. Six of 59 patients (10 per cent) had a major complication (cyst formation or sepsis), which could be resolved with minimal therapy, but prolonged hospital stay. Thirty-four patients (58 per cent) were symptomatic at presentation. There were no significant differences in symptoms before TAE and symptoms evaluated in the short term (within 3 months) after TAE (P = 0·134). First follow-up imaging was performed a median of 5·5 months after TAE and showed a reduction in size to a median of 48 mm (P < 0·001). CONCLUSION TAE is safe, can lead to adequate size reduction of HCA and, offers an alternative to resection in selected patients.
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Affiliation(s)
- B V van Rosmalen
- Department of Surgery, Amsterdam University Medical Centres, location AMC, Amsterdam, the Netherlands
| | - A J Klompenhouwer
- Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - J Jaap de Graeff
- Department of Surgery, Amsterdam University Medical Centres, location AMC, Amsterdam, the Netherlands
| | - M P D Haring
- Division of Hepatopancreatobiliary Surgery and Liver Transplantation, University Medical Centre Groningen, University of Groningen, Maastricht, the Netherlands
| | - V E de Meijer
- Division of Hepatopancreatobiliary Surgery and Liver Transplantation, University Medical Centre Groningen, University of Groningen, Maastricht, the Netherlands
| | - L Rifai
- Division of Hepatopancreatobiliary Surgery, Beaujon Hospital, University of Paris, Clichy, France
| | - S Dokmak
- Division of Hepatopancreatobiliary Surgery, Beaujon Hospital, University of Paris, Clichy, France
| | - A Rawashdeh
- Division of Hepatopancreatobiliary Surgery, Southampton General Hospital, Southampton, UK
| | - M Abu Hilal
- Division of Hepatopancreatobiliary Surgery, Southampton General Hospital, Southampton, UK
| | - M C de Jong
- Division of Hepatopancreatobiliary Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - C H C Dejong
- Department of Surgery and School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Surgery, Universitätsklinikum Aachen, Aachen, Germany
| | - M Doukas
- Department of Pathology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - R A de Man
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - J N M IJzermans
- Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - O M van Delden
- Department of Interventional Radiology, Amsterdam University Medical Centres, location AMC, Amsterdam, the Netherlands
| | - J Verheij
- Department of Pathology, Amsterdam University Medical Centres, location AMC, Amsterdam, the Netherlands
| | - T M van Gulik
- Department of Surgery, Amsterdam University Medical Centres, location AMC, Amsterdam, the Netherlands
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15
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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: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Indexed: 12/19/2022]
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16
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Védie AL, Sutter O, Ziol M, Nault JC. Molecular classification of hepatocellular adenomas: impact on clinical practice. Hepat Oncol 2018; 5:HEP04. [PMID: 30302195 PMCID: PMC6168043 DOI: 10.2217/hep-2017-0023] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 02/20/2018] [Indexed: 12/11/2022] Open
Abstract
Hepatocellular adenomas are rare benign liver tumors usually developing in young women using oral contraception. The two main complications are hemorrhage (10–20%) and malignant transformation into hepatocellular carcinoma (<5%). A molecular classification has been recently updated in six major subgroups, linked to risk factors, histology, imaging and clinical features: adenomas inactivated for HNF1A, inflammatory adenomas, β-catenin-activated adenomas mutated in exon 3, β-catenin-activated adenomas mutated in exon 7–8, sonic hedgehog adenomas, and unclassified adenomas. Indeed, β-catenin-mutated adenomas in exon 3 are associated with malignant transformation, and sonic hedgehog adenomas with bleeding. This new nosology of hepatocellular adenomas will help to stratify patients according to risk of complications and will guide therapeutics in the future.
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Affiliation(s)
- Anne-Laure Védie
- Service d'Hépatologie, Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, France.,Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France.,Service d'Hépatologie, Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, France.,Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France
| | - Olivier Sutter
- Service de Radiologie, Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France.,Service de Radiologie, Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France
| | - Marianne Ziol
- Service d'Anatomopathologie, Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance-publique Hôpitaux de Paris, Bondy, France.,Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France.,Service d'Anatomopathologie, Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance-publique Hôpitaux de Paris, Bondy, France.,Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France
| | - Jean-Charles Nault
- Service d'Hépatologie, Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, France.,Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France.,Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France.,Service d'Hépatologie, Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, France.,Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France.,Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France
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17
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Mironov O, Jaberi A, Beecroft R, Kachura JR. Retrospective Single-Arm Cohort Study of Patients with Hepatocellular Adenomas Treated with Percutaneous Thermal Ablation. Cardiovasc Intervent Radiol 2018; 41:935-941. [DOI: 10.1007/s00270-018-1893-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 01/31/2018] [Indexed: 01/30/2023]
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18
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Foo SY, Paul L, Viswanathan S. Cystic degeneration of hepatic adenoma: a rare complication of hepatic adenoma. BJR Case Rep 2017; 4:20170056. [PMID: 30363203 PMCID: PMC6159147 DOI: 10.1259/bjrcr.20170056] [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: 04/22/2017] [Revised: 08/31/2017] [Accepted: 09/22/2017] [Indexed: 11/23/2022] Open
Abstract
This case report describes a rare complication of hepatic adenomata in a 33-year-old female. The patient initially presented with abdominal pain, and baseline imaging demonstrated several hepatic adenomas, the largest of which (approximately 8 cm) was adjacent to the inferior vena cava. Owing to the location of this adenoma, surgical/vascular intervention was deemed inappropriate. The patient was actively observed for approximately 4 years, and managed supportively during any recurrent episodes. With follow-up CT/MRI scans, the "natural history" of this particular lesion, including haemorrhage, thrombosis and infarction, was observed. However, as intervention was unsuitable, further MRI was performed in view of these complications, allowing observation of the end-stage features of the adenoma. Appearances were consistent with a rare complication of hepatic adenoma, i.e. cystic degeneration, a process well documented in uterine leiomyoma.
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Affiliation(s)
- Sin Yee Foo
- Radiology, ST4 Radiology, West of Scotland Deanery, Glasgow, Scotland
| | - Laura Paul
- Radiology, ST2 Radiology, West of Scotland Deanery, Glasgow, Scotland
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19
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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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20
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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: 1.4] [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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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: 4.1] [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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Ziemlewicz TJ, Wells SA, Lubner MG, Brace CL, Lee FT, Hinshaw JL. Hepatic Tumor Ablation. Surg Clin North Am 2016; 96:315-39. [PMID: 27017867 DOI: 10.1016/j.suc.2015.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Tumor ablation is a safe and effective treatment available in the multidisciplinary care of the surgical oncology patient. The role of ablation is well established in the treatment of hepatocellular carcinoma and is becoming more accepted in the treatment of various malignancies metastatic to the liver, in particular colorectal cancer. Understanding the underlying technology, achieving appropriate applicator placement, using maximum energy delivery to create margins, and performing necessary adjunctive maneuvers are all required for successful tumor ablation.
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Affiliation(s)
- Timothy J Ziemlewicz
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue MC 3252, Madison, WI 53792, USA.
| | - Shane A Wells
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue MC 3252, Madison, WI 53792, USA
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue MC 3252, Madison, WI 53792, USA
| | - Christopher L Brace
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue MC 3252, Madison, WI 53792, USA; Department of Biomedical Engineering, University of Wisconsin, 1415 Engineering Drive, Madison, WI 53706, USA
| | - Fred T Lee
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue MC 3252, Madison, WI 53792, USA; Department of Biomedical Engineering, University of Wisconsin, 1415 Engineering Drive, Madison, WI 53706, USA
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue MC 3252, Madison, WI 53792, USA
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23
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Should fat in the radiofrequency ablation zone of hepatocellular adenomas raise suspicion for residual tumour? Eur Radiol 2016; 27:1704-1712. [PMID: 27436025 DOI: 10.1007/s00330-016-4496-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 06/22/2016] [Accepted: 06/29/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To assess the significance of fat in the radiofrequency ablation (RFA) zone of hepatocellular adenomas (HCA), and its association with tumoral fat and hepatic steatosis. METHODS The radiological archive was searched for patients with ablated HCAs and follow-up magnetic resonance imaging between January 2008 and June 2014. Age, sex, risk factors and duration of clinical and imaging follow-up were recorded. Pre-RFA imaging was assessed for tumour size, intra-tumoral fat and steatosis. Post-RFA imaging was reviewed for size, enhancement and intra-ablational fat. Intra-ablational fat was classified as peripheral, central or mixed; the association of these distributions with steatosis and tumoral fat was assessed using Fisher's exact test. RESULTS Sixteen patients with 26 ablated HCAs were included. Fat was present in 23/26 (88 %) ablation zones. Only 1/26 (4 %) showed serial enlargement and enhancement suggestive of residual disease; the enhancing area did not contain fat. All remaining ablations showed involution and/or diminishing fat content without suspicious enhancement (mean follow-up, 27 months; range, 2-84 months). The peripheral and mixed/central patterns of intra-ablational fat were associated with steatosis (P = 0.0005) and tumoral fat (P = 0.0003), respectively. CONCLUSION Fat in the ablation zone of HCAs is a common finding which, in isolation, does not indicate residual tumour. KEY POINTS • Fat in the RFA zone of HCAs is a common finding on MRI. • The distribution of fat is associated with hepatic steatosis and intra-tumoral fat. • In isolation, intra-ablational fat of treated HCAs does not indicate residual tumour.
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Microwave Ablation for the Treatment of Hepatic Adenomas. J Vasc Interv Radiol 2016; 27:244-9. [DOI: 10.1016/j.jvir.2015.09.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/26/2015] [Accepted: 09/27/2015] [Indexed: 02/07/2023] Open
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Wells SA, Hinshaw JL, Lubner MG, Ziemlewicz TJ, Brace CL, Lee FT. Liver Ablation: Best Practice. Radiol Clin North Am 2015; 53:933-71. [PMID: 26321447 DOI: 10.1016/j.rcl.2015.05.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Tumor ablation in the liver has evolved to become a well-accepted tool in the management of increasing complex oncologic patients. At present, percutaneous ablation is considered first-line therapy for very early and early hepatocellular carcinoma and second-line therapy for colorectal carcinoma liver metastasis. Because thermal ablation is a treatment option for other primary and secondary liver tumors, an understanding of the underlying tumor biology is important when weighing the potential benefits of ablation. This article reviews ablation modalities, indications, patient selection, and imaging surveillance, and emphasizes technique-specific considerations for the performance of percutaneous ablation.
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Affiliation(s)
- Shane A Wells
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA.
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA
| | - Timothy J Ziemlewicz
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA
| | - Christopher L Brace
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA; Department of Biomedical Engineering, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA
| | - Fred T Lee
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA; Department of Biomedical Engineering, University of Wisconsin, 600 Highland Avenue, CSC, Madison, WI 53792, USA
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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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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: 6.2] [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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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: 10] [Impact Index Per Article: 1.1] [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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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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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: 19] [Impact Index Per Article: 2.1] [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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Belghiti J, Cauchy F, Paradis V, Vilgrain V. Diagnosis and management of solid benign liver lesions. Nat Rev Gastroenterol Hepatol 2014; 11:737-49. [PMID: 25178878 DOI: 10.1038/nrgastro.2014.151] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
More and more asymptomatic benign liver tumours are discovered incidentally and can be divided into regenerative lesions and true neoplastic lesions. The most common regenerative lesions include hemangioma, focal nodular hyperplasia and inflammatory pseudotumours of the liver. Neoplastic lesions include hepatocellular adenomas and angiomyolipomas. Regenerative lesions rarely increase in volume, do not yield a higher risk of complications and usually do not require treatment. By contrast, hepatocellular adenomas and angiomyolipomas can increase in volume and are associated with a risk of complications. Large hepatocellular adenomas (>5 cm in diameter) are undoubtedly associated with a risk of bleeding and malignant transformation, particularly the inflammatory (also known as telangiectatic) and β-catenin mutated subtypes. Accurate diagnosis needs to be obtained to select patients eligible for surgical resection. MRI has markedly improved diagnosis and can identify the major hepatocellular adenomas subtypes. The use of biopsy results to inform the indication for resection remains questionable. However, when diagnosis remains uncertain after imaging, percutaneous biopsy could help improve diagnostic accuracy.
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Affiliation(s)
- Jacques Belghiti
- Department of Hepatobiliary Surgery and Liver Transplantation, Beaujon Hospital, University Paris-Diderot, 100 Boulevard du General Leclerc, 92110 Clichy, France
| | - François Cauchy
- Department of Hepatobiliary Surgery and Liver Transplantation, Beaujon Hospital, University Paris-Diderot, 100 Boulevard du General Leclerc, 92110 Clichy, France
| | - Valérie Paradis
- Department of Pathology, Beaujon Hospital, University Paris-Diderot, 100 Boulevard du General Leclerc, 92110 Clichy, France
| | - Valérie Vilgrain
- Department of Radiology, Beaujon Hospital, University Paris-Diderot, 100 Boulevard du General Leclerc, 92110 Clichy, France
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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: 0.8] [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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33
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Bieze M, Busch ORC, Tanis PJ, Verheij J, Phoa SSKS, Gouma DJ, van Gulik TM. Outcomes of liver resection in hepatocellular adenoma and focal nodular hyperplasia. HPB (Oxford) 2014; 16:140-9. [PMID: 23509949 PMCID: PMC3921009 DOI: 10.1111/hpb.12087] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 02/01/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The clinical management of hepatocellular adenoma (HCA) and focal nodular hyperplasia (FNH) is still subject to controversy, especially with respect to patient selection for surgery. The aim of this prospective cohort study was to assess the outcomes of surgical intervention. METHODS Between January 2008 and September 2012, patients diagnosed with FNH or HCA based on magnetic resonance imaging or computed tomography were enrolled in this prospective study. Resection was undertaken in patients with HCA of > 5 cm or symptomatic lesions. Lesion characteristics, extent of liver resection (minor: fewer than three segments; major: three or more segments), morbidity (by Dindo-Clavien class), mortality, postoperative length of stay and symptoms [McGill Pain Questionnaire, including a visual analogue scale (VAS)] were evaluated. RESULTS A total of 110 patients (106 female; median age: 39 years) were included; 51 patients had HCA and 59 had FNH. Of the 110 patients, 49 underwent resection (33 HCA patients; 16 FNH patients). Laparoscopic minor resection was performed in five HCA and five FNH patients; open minor resection was performed in 19 HCA and seven FNH patients, and open major resection was performed in nine HCA and four FNH patients. Severe postoperative complications were observed in four patients (Grade III, n = 3; Grade IV, n = 1). Median baseline scores on the VAS were 6 in FNH patients and 7 in HCA patients; the median VAS score after resection was 0 (P = 0.008). CONCLUSIONS If patients with HCA and FNH require surgery, limited resection can be carried out with low morbidity and without mortality. Patients with preoperative symptoms show a high rate of postoperative symptom relief.
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Affiliation(s)
- Matthanja Bieze
- Department of Surgery, Academic Medical CentreAmsterdam, the Netherlands,Matthanja Bieze, Academic Medical Centre, IWO 1-A1-132, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. Tel: + 31 20 566 6653. Fax: + 31 20 697 6621. E-mail:
| | - Olivier R C Busch
- Department of Surgery, Academic Medical CentreAmsterdam, the Netherlands
| | - Pieter J Tanis
- Department of Surgery, Academic Medical CentreAmsterdam, the Netherlands
| | - Joanne Verheij
- Department of Pathology, Academic Medical CentreAmsterdam, the Netherlands
| | - Saffire S K S Phoa
- Department of Radiology, Academic Medical CentreAmsterdam, the Netherlands
| | - Dirk J Gouma
- Department of Surgery, Academic Medical CentreAmsterdam, the Netherlands
| | - Thomas M van Gulik
- Department of Surgery, Academic Medical CentreAmsterdam, the Netherlands
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Ramia JM, Bernardo C, Valdivieso A, Dopazo C, Jover JM, Albiol MT, Pardo F, Fernandez Aguilar JL, Gutierrez Calvo A, Serrablo A, Diez Valladares L, Pereira F, Sabater L, Muffak K, Figueras J. [Multicentre study on hepatic adenomas]. Cir Esp 2014; 92:120-5. [PMID: 23827931 DOI: 10.1016/j.ciresp.2012.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 12/02/2012] [Accepted: 12/16/2012] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Hepatic adenomas (HA) are benign tumours which can present serious complications, and as such, in the past all were resected. It has now been shown that those smaller than 3 cm not expressing β-catenin only result in complications in exceptional cases and therefore the therapeutic strategy has been changed. MATERIAL AND METHOD Retrospective study in 14 HPB units. INCLUSION CRITERIA patients with resected and histologically confirmed HA. STUDY PERIOD 1995-2011. RESULTS 81 patients underwent surgery. Age: 39.5 years (range: 14-75). Sex: female (75%). Consumption of oestrogen in women: 33%. Size: 8.8 cm (range, 1-20 cm). Only 6 HA (7.4%) were smaller than 3 cm. The HA median was 1 (range: 1-12). Nine patients had adenomatosis (>10HA). A total of 51% of patients displayed symptoms, the most frequent (77%) being abdominal pain. Eight patients (10%) began with acute abdomen due to rupture and/or haemorrhage. A total of 67% of the preoperative diagnoses were correct. Surgery was scheduled for 90% of patients. The techniques employed were: major hepatectomy (22%), minor hepatectomy (77%) and one liver transplantation. A total of 20% were performed laparoscopically. The morbidity rate was 28%. There were no cases of mortality. Three patients had malignisation (3.7%). The follow-up period was 43 months (range 1-192). Two recurrences were detected and resected. DISCUSSION Patients with resected HA are normally women with large lesions and oestrogen consumption was lower than expected. Its correct preoperative diagnosis is acceptable (70%). The major hepatectomy rate is 25% and the laparoscopy rate is 20%. There was a low morbidity rate and no mortality.
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Affiliation(s)
- José Manuel Ramia
- Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital Universitario de Guadalajara, Guadalajara, España.
| | - Carmen Bernardo
- Sección Hepatobiliopancreática y de Trasplante Hepático, Servicio de Cirugía, Hospital Central de Asturias, Oviedo, España
| | - Andrés Valdivieso
- Unidad Hepatobiliopancreática y de Trasplante Hepático, Servicio de Cirugía, Hospital de Cruces, Bilbao, España
| | - Cristina Dopazo
- Unidad Hepatobiliopancreática y de Trasplante Hepático, Servicio de Cirugía, Hospital Vall d'Hebron, Barcelona, España
| | - José María Jover
- Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital de la Cruz Roja, Getafe, Madrid, España
| | - M Teresa Albiol
- Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital Josep Trueta, Girona, España
| | - Fernando Pardo
- Unidad Hepatobiliopancreática, Servicio de Cirugía, Clínica Universitaria de Navarra, Pamplona, España
| | - José Luis Fernandez Aguilar
- Unidad Hepatobiliopancreática, Unidad de Gestión Clinica de Cirugía General, Digestiva y Trasplantes, Servicio de Cirugía, Hospital Carlos Haya, Málaga, España
| | - Alberto Gutierrez Calvo
- Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - Alejandro Serrablo
- Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital Miguel Servet, Zaragoza, España
| | - Luis Diez Valladares
- Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital Clínico San Carlos, Madrid, España
| | - Fernando Pereira
- Servicio de Cirugía, Hospital de Fuenlabrada, Fuenlabrada, Madrid, España
| | - Luis Sabater
- Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital Clínico Universitario, Valencia, España
| | - Karim Muffak
- Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital Virgen de las Nieves, Granada, España
| | - Joan Figueras
- Unidad Hepatobiliopancreática, Servicio de Cirugía, Hospital Josep Trueta, Girona, España
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Radiofrequency ablation of a large hepatic adenoma in a child. J Pediatr Surg 2013; 48:E19-22. [PMID: 23845652 DOI: 10.1016/j.jpedsurg.2013.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 04/01/2013] [Accepted: 04/20/2013] [Indexed: 02/03/2023]
Abstract
Hepatic adenomas are rare benign liver tumors seen most commonly in young women on oral contraceptives. Large hepatic adenomas are at risk of malignant transformation and require treatment in select patients, usually by surgical resection. Radiofrequency ablation (RFA) has become a widely used and accepted tool for the curative treatment of small primary hepatocellular carcinomas in adults; however, its use in the treatment of other liver lesions, such as hepatic adenoma, has only recently been described. Use of RFA for liver lesions in pediatric population remains novel. We present a case of large hepatic adenoma successfully treated with RFA in a child with chronic liver disease secondary to alpha-1-antitrypsin deficiency. RFA may be an attractive option in pediatric liver tumor management in selected cases because of its less invasive characteristics.
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Nault JC, Bioulac-Sage P, Zucman-Rossi J. Hepatocellular benign tumors-from molecular classification to personalized clinical care. Gastroenterology 2013; 144:888-902. [PMID: 23485860 DOI: 10.1053/j.gastro.2013.02.032] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 02/20/2013] [Accepted: 02/20/2013] [Indexed: 12/12/2022]
Abstract
Focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) are benign hepatocellular tumors that develop most frequently in women without cirrhosis. Genomic approaches have identified signaling pathways related to these benign hepatocyte proliferations. FNH, a polyclonal lesion, is characterized by local vascular abnormalities and heterogeneous activation of Wnt/β-catenin and transforming growth factor β signaling. Four major subgroups of HCAs have been identified based on mutations in specific oncogenes and tumor suppressor genes. Each molecular subtype of HCA has been associated with specific pathways, providing new information about benign tumorigenesis. Key features include metabolic alterations (induced by defects in HNF1A), oncogene-induced inflammation (activation of JAK-STAT signaling in inflammatory adenomas), and an association between activation of Wnt/β-catenin signaling and progression of HCAs in hepatocellular carcinomas. Benign hepatocellular tumors can be classified using immunohistochemical analyses. Studies of genotypes and phenotypes of FNH and HCAs have led to the identification of risk factors and improved invasive and noninvasive diagnostic techniques, evaluation of prognosis, and treatment. We review the molecular pathways involved in benign hepatocyte proliferation and discuss how this basic knowledge has been progressively translated into personalized clinical care.
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Affiliation(s)
- Jean-Charles Nault
- INSERM, UMR-674, Génomique Fonctionnelle des Tumeurs Solides, IUH, Paris, France
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Karkar AM, Tang LH, Kashikar ND, Gonen M, Solomon SB, DeMatteo RP, D' Angelica MI, Correa-Gallego C, Jarnagin WR, Fong Y, Getrajdman GI, Allen P, Kingham TP. Management of hepatocellular adenoma: comparison of resection, embolization and observation. HPB (Oxford) 2013; 15:235-43. [PMID: 23374365 PMCID: PMC3572286 DOI: 10.1111/j.1477-2574.2012.00584.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 08/26/2012] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Hepatocellular adenoma (HA) is an uncommon benign hepatic tumour with the potential for malignant change or spontaneous haemorrhage. Resection has been the recommended treatment, but outcomes with other approaches are ill defined. METHODS Demographic and outcomes data were retrospectively collected on patients diagnosed with HA at a tertiary hepatobiliary centre from 1992-2011 whom underwent resection, bland embolization or observation. RESULTS In total, 52 patients with 100 adenomas were divided into single HA (n = 27), multiple HA (n = 18), and adenomatosis (n = 7) groups. Eighty-seven per cent were female and 37% had a history of hormone use. Median sizes of resected, embolized and observed adenomas were 3.6 cm, 2.6 cm and 1.2 cm, respectively. Forty-eight adenomas were resected as a result of suspicion of malignancy (39%) or large size (39%); 61% of these were solitary. Thirty-seven were embolized for suspicion of malignancy (56%) or hsemorrhage (20%); 92% of these were multifocal. Two out of three resected adenomas with malignancy were ≥10 cm and recurred locally [4%, confidence interval (CI) 1-14%]. Ninety-two per cent of the embolized adenomas were effectively treated; three persisted (8.1%, CI 2-22%). Most observed lesions did not change over time. CONCLUSIONS While solitary adenomas are often resected, multifocal HAs are frequently embolized. Small adenomas can safely be observed. Given low recurrence rates, select HAs can be considered for embolization.
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Affiliation(s)
- Ami M. Karkar
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Laura H. Tang
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Nilesh D. Kashikar
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Mithat Gonen
- Department of Pathology, Lenox Hill Hospital, New York, NY, USA
| | - Stephen B. Solomon
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Ronald P. DeMatteo
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | | | - William R. Jarnagin
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Yuman Fong
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Peter Allen
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Benign hepatocellular tumors in children: focal nodular hyperplasia and hepatocellular adenoma. Int J Hepatol 2013; 2013:215064. [PMID: 23555058 PMCID: PMC3608344 DOI: 10.1155/2013/215064] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 02/05/2013] [Indexed: 12/11/2022] Open
Abstract
Benign liver tumors are very rare in children. Most focal nodular hyperplasia (FNH) remain sporadic, but predisposing factors exist, as follows: long-term cancer survivor (with an increasing incidence), portal deprivation in congenital or surgical portosystemic shunt. The aspect is atypical on imaging in two-thirds of cases. Biopsy of the tumor and the nontumoral liver is then required. Surgical resection will be discussed in the case of large tumors with or without symptoms. In the case of associated vascular disorder with portal deprivation, restoration of the portal flow will be discussed in the hope of seeing the involution of FNH. HepatoCellular Adenoma (HCA) is frequently associated with predisposing factors such as GSD type I and III, Fanconi anemia especially if androgen therapy is administered, CPSS, and SPSS. Adenomatosis has been reported in germline mutation of HNF1- α . Management will depend on the presence of a predisposing factor and may include metabolic control, androgen therapy withdrawn, or closure of the shunt when appropriate. Surgery is usually performed on large lesions. In the case of adenomatosis or multiple lesions, surgery will be adapted. Close followup is required in all cases.
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Jindal G, Gemmete J, Gandhi D. Interventional Neuroradiology Applications in Otolaryngology, Head and Neck Surgery. Otolaryngol Clin North Am 2012; 45:1423-49. [DOI: 10.1016/j.otc.2012.08.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Liver tumors in children can be classified into benign or malignant; some of the benign lesions can have the potential of malignant transformation, and therefore the therapeutic approach may change. These neoplasms account for nearly 1-2% of all pediatric tumors and they have gained significant attention in the last decades due to data suggesting that the incidence may be increasing 5% annually. We know that with new and improved imaging modalities some of these lesions may be detected more often than before. Recent studies showed that liver cancer represented 2% of malignancies in infants by 1980s and this was doubled in incidence to 4% in the following 10 yr. In this review our aim is to discuss all primary liver tumors in children with attention to their clinicopathological and immunohistochemical features followed by the current standard of care.
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Affiliation(s)
- Sukru Emre
- Department of Surgery, Yale University School of Medicine, Yale, New Haven, CT, USA.
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