Clinical Image
Conservative management of hepatic adenomas
1 MBBS, M. Surg (Sydney), Clinical Lecturer, University of Tasmania, Launceston General Hospital, Launceston, Australia
Address correspondence to:
Christopher Cheong
MBBS, M. Surg (Sydney), Clinical Lecturer, University of Tasmania, Launceston General Hospital, Launceston,
Australia
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Article ID: 100114Z12CC2022
doi: 10.5348/100114Z12CC2022CI
How to cite this article
Cheong C. Conservative management of hepatic adenomas. J Case Rep Images Surg 2022;8(2):51–52.ABSTRACT
No Abstract
Case Report
A 27-year-old female presented to the emergency department with a one week history of right upper quadrant pain. She had no past medical history but was currently on the combined oral contraceptive pill (OCP) for birth control. Following that, the patient had a computed tomography (CT) and subsequent magnetic resonance imaging of her liver which showed multiple hepatic adenomas, the largest being in segment 8 (64 × 73 × 57 mm) and segment 6 (45 × 38 × 32 mm) (Figure 1A). This was managed conservatively by ceasing the OCP and after one year and three months showed almost complete resolution on magnetic resonance imaging (MRI) imaging at clinic follow-up (Figure 1B).
Discussion
Hepatic adenomas (HAs) are benign solid liver tumors. They are strongly associated with the use of external sex hormones (OCP and anabolic steroid use). Although largely regarded as benign tumors, they have a small risk of malignant transformation (<5%) [1]. Surgical resection is commonly recommended for HA larger than 5 cm due to the risk of spontaneous rupture and malignant transformation [2],[3]. However, there has now been a shift toward non-surgical management of HA [2].
Current literature shows no agreed consensus on the management of HA. It is recommended that HAs larger than 5 cm be surgically resected due to the risk of hemorrhage [4]. However, the case report shows that even large hepatic adenomas (greater than 5 cm) can be conservatively managed with the withdrawal of exogenous estrogen. However, this author would like to add a note of caution that conservative management of HAs incurs a greater risk of malignant transformation in males [2]. For patients with β-catenin mutation in HA there is still unclear evidence that it leads to an increased risk of malignant transformation [3].
Conclusion
No consensus has been shown on the management of hepatic adenomas. Generally, surgical resection is recommended for HA larger than 5 cm because of the risk of hemorrhage. There has now been a shift toward non-surgical management of HA.
REFERENCE
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Krause K, Tanabe KK. A shifting paradigm in diagnosis and management of hepatic adenoma. Ann Surg Oncol 2020;27(9):3330–8. [CrossRef]
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Micchelli STL, Vivekanandan P, Boitnott JK, Pawlik TM, Choti MA, Torbenson M. Malignant transformation of hepatic adenomas. Mod Pathol 2008;21(4):491–7. [CrossRef]
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Tsilimigras DI, Rahnemai-Azar AA, Ntanasis-Stathopoulos I, et al. Current approaches in the management of hepatic adenomas. J Gastrointest Surg 2019;23(1):199–209. [CrossRef]
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SUPPORTING INFORMATION
Author Contributions
Christopher Cheong - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Data Availability StatementThe corresponding author is the guarantor of submission.
Consent For PublicationWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Competing InterestsAuthor declares no conflict of interest.
Copyright© 2022 Christopher Cheong. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.