What is the mortality and morbidity associated with hepatocellular adenoma (HCA)?

Updated: Feb 21, 2018
  • Author: Bradford A Whitmer, DO; Chief Editor: BS Anand, MD  more...
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Answer

Nearly 20-25% of cases have right upper quadrant pain, and 30-40% experience hemorrhage (one third within the mass, two thirds into the abdomen).

In a systematic review including a total of 1176 patients, the overall frequency of hemorrhage was 27.2%. Hemorrhage occurred in 15.8% of all hepatocellular adenoma lesions. Rupture and intraperitoneal bleeding were reported in 17.5% of patients. [25]

Although a tumor size of 5 cm is the standard for resection owing to the increased risk of hemorrhage and malignant transformation, multiple case series have reported hemorrhage in sizes less than 5 cm, even as small as 1 cm. [26]  The risk, though, appears to be minimal. The risk of hemorrhage appears to be related to size and not related to the number of lesions. Multiple studies did not find a difference between patients with a single or multiple hepatocellular adenomas. [27, 28, 29]

The mortality rate associated with an acute hemorrhage into the peritoneum may be as high as 25-30% in patients with large tumors (>5 cm).

The risk of malignant transformation is not completely known and may be as high as 13% based on small studies. A recent systematic review incorporating all reports on malignant degeneration of hepatocellular adenoma into hepatocellular carcinoma showed an overall risk of 4.2%, with only 4.4% of these malignant transformations occurring in lesions less than 5 cm in diameter. [24]

HCA combined with chronic hepatitis B infection could increase the risk of malignant transformation, but more studies are needed. [23]

Pregnancy has been associated with hepatic adenoma, and rupture of the adenoma during pregnancy has been associated with high rates of maternal and fetal mortality.


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