New Insights in the Management of Hepatocellular Adenoma

Anne J. Klompenhouwer; Robert A. de Man; Marco Dioguardi Burgio; Valerie Vilgrain; Jessica Zucman-Rossi; Jan N. M. Ijzermans

Disclosures

Liver International. 2020;40(7):1529-1537. 

In This Article

Abstract and Introduction

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 Epidemiological data are fairly outdated, but it is likely to assume that the incidence has increased over the past decades as HCA are more often incidentally found due to the more widespread use of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.

Introduction

Hepatocellular adenoma (HCA) is a benign liver tumour that may be complicated by haemorrhage or malignant transformation to hepatocellular carcinoma (HCC). Risk factors for HCA include long-term use of the oral contraceptive pill (OC),[1,2] obesity and the metabolic syndrome,[3–5] androgen consumption[6] and genetic disorders such as MODY-3 and glycogen storage disease.[7–9] Two clinical practice guidelines have been issued on the management of benign liver tumours: the first from the American College of Gastroenterology (ACG, dating from 2014) and the second from the European Association for the Study of the Liver (EASL, dating from 2016).[10,11] Since the publication of these guidelines, much progress has been made in the field of hepatocellular adenoma. In this review, we describe the major recent advances in this field, including epidemiology, diagnosis (imaging and pathology), prognosis and treatment and discuss the implications in clinical practice.

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