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Current Gastroenterology Reports
Published in: Current Gastroenterology Reports 3/2015

01-03-2015 | Liver (B Bacon, Section Editor)

Management of Hepatic Adenomatosis

Authors: Manish Thapar, Oleg Grapp, Constantine Fisher

Published in: Current Gastroenterology Reports | Issue 3/2015

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Abstract

Hepatic adenomatosis (HeAs) is a rare clinical entity defined by the presence of 10 or more hepatic adenomas (HA) within the background of an otherwise normal liver parenchyma, in the absence of glycogen storage disease or anabolic steroid use. HA is a benign tumor associated with oral contraceptive use. Recent advances in pathogenesis and classification of HA have questioned the distinction between these two diseases. HA are currently classified into four different subtypes with genotypic and phenotypic correlation: HNF-1a inactivated HA, B-catenin activated HA, inflammatory HA, and undetermined subtype. The clinical presentation of HA depends on the lesion size and the subtype. MRI using hepatospecific contrast agents is helpful in diagnosing the most common subtypes. When diagnosis is uncertain, biopsy with immunohistochemistry is used to diagnose and classify the lesions. Management is governed by the molecular subtype and tumor size. Pregnancy is not routinely discouraged but management is individualized.
Literature
1.
Flejou JF, Barge J, Menu Y, Degott C, Bismuth H, Potet F, et al. Liver adenomatosis. An entity distinct from liver adenoma? Gastroenterology. 1985;89(5):1132–8.PubMed
2.
Zucman-Rossi J, Jeannot E, Nhieu JT, Scoazec JY, Guettier C, Rebouissou S, et al. Genotype-phenotype correlation in hepatocellular adenoma: new classification and relationship with HCC. Hepatology. 2006;43(3):515–24.CrossRefPubMed
3.
Bioulac-Sage P, Rebouissou S, Thomas C, Blanc JF, Saric J, Sa Cunha A, et al. Hepatocellular adenoma subtype classification using molecular markers and immunohistochemistry. Hepatology. 2007;46(3):740–8.CrossRefPubMed
4.
Frulio N, Chiche L, Bioulac-Sage P, Balabaud C. Hepatocellular adenomatosis: what should the term stand for. Clin Res Hepatol Gastroenterol. 2014;38(2).
5.
Rooks JB, Ory HW, Ishak KG, Strauss LT, Greenspan JR, Hill AP, et al. Epidemiology of hepatocellular adenoma: the role of oral contraceptive use. JAMA. 1979;242(7):644–8.CrossRefPubMed
6.••
Nault JC, Bioulac-Sage P, Zucman-Rossi J. Hepatocellular benign tumors—from molecular classification to personalized clinical care. Gastroenterology. 2013;144(5):888–902. Review article summarizing current understanding of pathological classification of hepatic adenomas using novel immunohistochemical techniques. It also discusses the molecular pathways in adenoma development.CrossRefPubMed
7.
8.
Barthelmes L, Tait IS. Liver cell adenoma and liver cell adenomatosis. HPB (Oxford). 2005;7(3):186–96.CrossRef
9.•
Bioulac-Sage P, Cubel G, Balabaud C, Zucman-Rossi J. Revisiting the pathology of resected benign hepatocellular nodules using new immunohistochemical markers. Semin Liver Dis. 2011;31(1):91–103. Description of immunohistochemistry techniques used to identify different subtypes of hepatocellular adenomas. It also discusses the performance characteristics of these techniques.CrossRefPubMed
10.
Edmondson HA, Reynold TB, Henderson B, Benton B. Regression of liver cell adenomas associated with oral contraceptives. Ann Int Med. 1977;86(2):180–2.CrossRefPubMed
11.
Furlan A, van der Windt DJ, Nalesnik MA, Sholosh B, Ngan KK, Pealer KM, et al. Multiple hepatic adenomas associated with liver steatosis at CT and MRI: a case–control study. AJR Am J Roentgenol. 2008;191(5):1430–5.CrossRefPubMed
12.•
Srirattanapong S, Angthong W, Kim BS, Hayashi PH, Gerber DA, Woosley JT, et al. Liver adenomatosis: serial investigation on MRI. Abdom Imaging. 2014;39(2):269–82. This is a retrospective series of 18 patients with liver adenomatosis and summarizes MRI findings and clinical course.CrossRefPubMed
13.••
Bunchorntavakul C, Bahirwani R, Drazek D, Soulen MC, Siegelman ES, Furth EE, et al. Clinical history and natural history of hepatocellular adenomas: the impact of obesity. Aliment Pharmacol Ther. 2011;34(6):664–74. The authors evaluate the role of obesity and metabolic syndrome in the development of hepatic adenomas. These disorders play an important role in the inflammatory subtype of hepatic adenomas.CrossRefPubMed
14.••
Bioulac-Sage P, Taouji S, Possenti L, Balabaud C. Hepatocellular adenoma sub-types: the impact of overweight and obesity. Liver Int. 2013;32(8):1217–21. The authors evaluate the role of obesity in hepatic adenoma development.CrossRef
15.
Parker P, Burr I, Slonim A, Ghishan FK, Greene H. Regression of hepatic adenomas in type 1a glycogen storage disease with dietary therapy. Gastroenterology. 1981;81(3):534–6.PubMed
16.
Rebouissou S, Imbeaud S, Balabaud C, Boulanger V, Bertrand-Michel J, Terce F, et al. HNF-1a inactivation promotes lipogenesis in human hepatocellular adenoma independently of SREBP-1 and carbohydrate-response element-binding protein (ChREBP) activation. J Biol Chem. 2007;282(19):14437–46.CrossRefPubMed
17.
Bacq Y, Jacquemin E, Balabaud C, Jeannot E, Scotto B, Branchereau S, et al. Familial liver adenomatosis associated with hepatocyte nuclear factor 1alpha inactivation. Gastroenterology. 2003;125(5):1470–5.CrossRefPubMed
18.
Rebouissou S, Amessou M, Couchy G, Poussin K, Imbeaud S, Pilati C, et al. Frequent in-frame somatic deletions activate gp130 in inflammatory hepatocellular tumours. Nature. 2009;457:200–4.CrossRefPubMedCentralPubMed
19.
Paradis V, Benzerkri A, Dargere D, Bieche I, Laurendeau I, Vilgrain V, et al. Telengiectatic focal nodular hyperplasia: a variant of hepatocellular adenoma. Gastroenterology. 2004;126(5):1323–9.CrossRefPubMed
20.
Sa Cunha A, Blanc JF, Lazaro E, Mellottee L, Le Bail B, Zucman-Rossi J, et al. Inflammatory syndrome with liver adenomatosis: the beneficial effects of surgical management. Gut. 2007;56(2):307–9.CrossRefPubMedCentralPubMed
21.
Cho SW, Marsh J, Steel J. Surgical management of hepatocellular adenoma: take it or leave it? Ann Surg Oncol. 2008;15:2795–803.CrossRefPubMed
22.
Dokmak S, Paradis V, Vilgrain V, Sauvanet A, Farges O, Valla D, et al. A single-center surgical experience of 122 patients with single and multiple hepatocellular adenomas. Gastroenterology. 2009;137(5):1698–705.CrossRefPubMed
23.
Deneve JL, Pawlik TM, Cunningham S, Clary B, Reddy S, Scoggins CR, et al. Liver cell adenoma: a multicenter analysis of risk factors for rupture and malignancy. Ann Surg Oncol. 2009;16:640–8.CrossRefPubMed
24.
Bioulac-Sage P, Laumonier H, Couchy G, Le Bail B, Sa Cunha A, Rullier A, et al. Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience. Hepatology. 2009;50(2):481–9.CrossRefPubMed
25.
Foster JH, Berman MM. The malignant transformation of liver cell adenomas. Arch Surg. 1994;129(7):712–7.CrossRefPubMed
26.
Farges O, Ferreira N, Dokmak S, Belghiti J, Bedossa P, Paradis V. Changing trends in malignant transformation of hepatocellular adenoma. Gut. 2010;60(1):85–9.CrossRef
27.
Gordon SC, Reddy KR, Livingstone AS, Jeffers LJ, Schiff ER. Resolution of a contraceptive-steroid-induced hepatic adenoma with subsequent evolution into hepatocellular carcinoma. Ann Int Med. 1986;105(4):547–9.CrossRefPubMed
28.
Tesluk H, Lawrie J. Hepatocellular adenoma: its transformation to carcinoma in a user of oral contraceptives. Arch Pathol Lab Med. 1981;105(6):296–9.PubMed
29.
30.
31.
Terkivatan T, de Wilt JH, de Man RA, van Rijn RR, Zondervan PE, Tilanus HW, et al. Indications and long-term outcome of treatment for benign hepatic tumors: a critical appraisal. Arch Surg. 2001;136(9):1033–8.CrossRefPubMed
32.
33.•
Raman SP, Hruban RH, Fishman EK. Hepatic adenomatosis: spectrum of imaging findings. Abdom Imaging. 2013;38(3):474–81. The authors discuss the imaging characteristics and differential diagnosis of hepatic adenomas.CrossRefPubMed
34.
Grazioli L, Federle MP, Brancatelli G, Ichikawa T, Olivetti L, Blachar A. Hepatic adenomas: imaging and pathologic findings. Radiographics. 2001;21(4):877–92.CrossRefPubMed
35.
Giovanoli O, Heim M, Terracciano L, Bongartz G, Ledermann HP. MRI of hepatic adenomatosis: initial observations with gadoxetic acid contrast agent in three patients. AJR Am J Roentgenol. 2008;190(5):W290–3.CrossRefPubMed
36.
Shanbhogue A, Shan SN, Zaheer A, Prasad SR, Takahashi N, Vikram R. Hepatocellular adenomas: current update on genetics, taxonomy, and management. J Comput Assist Tomogr. 2011;35(2):159–66.CrossRefPubMed
37.
Laumonier H, Bioulac-Sage P, Laurent C, Zucman-Rossi J, Balabaud C, Trillaud H. Hepatocellular adenomas: magnetic resonance imaging features as a function of molecular pathological classification. Hepatology. 2008;48(3):808–18.CrossRefPubMed
38.
Vetelainen R, Erdogan D, de Graaf W, ten Kate F, Jansen PL, Gouma DJ, et al. Liver adenomatosis: re-evaluation of aetiology and management. Liver Int. 2008;28(4):499–508.CrossRefPubMed
39.
Greaves WO, Bhattacharya B. Hepatic adenomatosis. Arch Pathol Lab Med. 2008;132(12):1951–5.PubMed
40.•
Dhingra S, Fiel MI. Update on the new classification of hepatic adenomas: clinical, molecular, and pathologic characteristics. 2014. The authors review the molecular and genetic biology of hepatic adenomas along with immunohistochemical and histopathological charaterstics.
41.••
Van Aalten SM WC, de Man RA, Ijzermans JN, Terkivatan T. Can a decision-making model be justified in the management of hepatocellular adenoma? Liver Int. 2012;32(31):28–37. Summarized current diagnostic and current treatment options for hepatic adenomas. The authors propose a decision model for adenoma management.CrossRefPubMed
42.
Wilson CH, Manas DM, French JJ. Laparoscopic liver resection for hepatic adenoma in pregnancy. J Clin Gastroenterol. 2011;45:828–33.CrossRefPubMed
43.
Yoshidome H, Morita K, Edwards M. Management issues regarding hepatic adenomatosis. Am Surg. 1999;65:1070–6.PubMed
44.
Ribeiro A, Burgart LJ, Nagorney DM, Gores GJ. Management of liver adenomatosis: results with a conservative surgical approach. Liver Transplant Surg. 1998;4(5):388–98.CrossRef
45.
Jenkins RL, Johnson L, Lewis D. Surgical approach to benign liver tumors. Semin Liver Dis. 1994;14:178–89.CrossRefPubMed
46.
Marrero JA, Ahn J, Reddy R. ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol. 2014;109(9):1328–47.CrossRefPubMed
47.
Venkatesh SK, Vishal C, Lewis RR. Liver masses: a clinical, radiological, and pathologic perspective. Clin Gastroenterol Hepatol. 2014;12(9):1414–29.CrossRefPubMed
48.
Huurman VA, Schaapherder AF. Management of ruptured hepatocellular adenoma. Dig Surg. 2010;27:56–60.CrossRefPubMed
49.
Kobayashi S, Sakaguchi H, Takatsuka M, Suekane M, Iwai S, Morikawa H, et al. Two cases of hepatocellular adenomatosis treated with transcatheter arterial embolization. Hepatol Int. 2009;3:416–20.CrossRefPubMedCentralPubMed
50.
Rhim H, Lim HK, Kim YS, Choi D. Percutaneous radiofrequency ablation of hepatocellular adenoma: initial experience in 10 patients. J Gastroenterol Hepatol. 2008;23(8 Pt 2):e422–7.CrossRefPubMed
51.
Fujita S, Kushihata F, Herrmann GE, Mergo PJ, Liu C, Nelson D, et al. Combined hepatic resection and radiofrequency ablation for multiple hepatic adenomas. J Gastroenterol Hepatol. 2006;21(8):1351–4.CrossRefPubMed
52.
Van Aalten SM, Terkivatan T, van der Linden E, Verheij J, de Man RA, Ijzermans JN. Management of liver adenomatosis by radiofrequency ablation. Dig Surg. 2011;28(3):173–7.CrossRefPubMed
53.
Marino IR, Scantlebury VP, Bronsther O, Iwatsuki S, Starzl TE. Total hepatectomy and liver transplant for hepatocellular adenomatosis and focal nodular hyperplasia. Transpl Int. 1992;5 Suppl 1:S201–5.PubMedCentralPubMed
54.
Yunta PJ, Moya A, San-Juan F, Lopez-Andujar R, De Juan M, Orbis F, et al. A new case of hepatic adenomatosis treated with orthotopic liver transplantation. Ann Chir. 2001;126(7):672–4.CrossRefPubMed
55.
Wellen JR, Anderson CD, Doyle M, Shenoy S, Nadler M, Turmelle Y, et al. The role of liver transplantation for hepatic adenomatosis in the pediatric population: case report and review of the literature. Pediatr Transplant. 2010;14(3):E16–9.CrossRefPubMed
56.
Lerut JP, Ciccarelli O, Sempoux C, Danse E, DeFlandre J, Horsmans Y, et al. Glycogenosis storage type I diseases and evolution adenomatosis: an indication for liver transplantation. Transpl Int. 2003;16(12):879–84.CrossRefPubMed
57.
Van Aalten SM, Verheij J, Terkivatan T, Dwarkasing RS, De Man RA, Ijzermans JN. J Hepatol. 2011;55(1):120–5.CrossRefPubMed
58.
Kent DR, Nissen ED, Nissen SE, Ziehm DJ. Effect of pregnancy on liver tumor associated with oral contraceptives. Obstet Gynecol. 1978;51(2):148–51.PubMed
59.
Shaked O, Siegelman ES, Olthoff K, Reddy KR. Biologic and clinical features of benign solid and cystic lesions of the liver. Clin Gastroenterol Hepatol. 2011;9(7):547–62.CrossRefPubMed
60.•
Broker ME, Ijzermans JN, Van Aalten SM, De Man RA, Terkivatan T. The management of pregnancy in women with hepatocellular adenoma: a plea for an individualized approach. Int J Hepatol. 2012:1–3. The article summarizes the management of hepatic adenomas in pregnant patients and proposes an algorithm for management.
61.••
Noels JE, Van Aalten SM, Van der Windt DJ, Kok NF, De Man RA, Terkivatan T, et al. Management of hepatocellular adenoma during pregnancy. J Hepatol. 2011;54(3):553–8. This article describes the outcomes of 17 pregnancies in 12 patients previously diagnosed with hepatic adenomas. The authors make suggestions for management based on their experience.CrossRefPubMed
62.
Cristiano A, Dietrich A, Spina JC, Ariles V, De Santibanes E. Focal nodular hyperplasia and hepatic adenoma: current diagnosis and management. Updat Surg. 2013;66(1):9–21.CrossRef
63.
Poussin K, Pilati C, Couchy G, Calderado J, Bioulac-Sage P, Bacq Y, et al. Biochemical and functional analyses of gp130 mutants unveil JAK1 as a novel therapeutic target in human inflammatory hepatocellular adenoma. Oncoimmunology. 2013;2(12):e27090.CrossRefPubMedCentralPubMed
Metadata
Title
Management of Hepatic Adenomatosis
Authors
Manish Thapar
Oleg Grapp
Constantine Fisher
Publication date
01-03-2015
Publisher
Springer US
Published in
Current Gastroenterology Reports / Issue 3/2015
Print ISSN: 1522-8037
Electronic ISSN: 1534-312X
DOI
https://doi.org/10.1007/s11894-015-0434-4
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