Management of patients with hepatocellular adenoma: a single‐institution experience

• Published in: ANZ journal of surgery Vol. 90; no. 5; pp. 786 - 790
• Main Authors: Nahm, Christopher B., Parker, Nicholas, Gundara, Justin S., Gill, Anthony J., Bhimani, Nazim, Samra, Jaswinder S., Hugh, Thomas J.
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.05.2020; Blackwell Publishing Ltd
• Subjects: Adenoma; Adenoma, Liver Cell - surgery; Adult; Aged; Aged, 80 and over; Bleeding; Body mass; Body mass index; Body size; Carcinoma, Hepatocellular; Catenin; Diagnostic systems; Embolization; Embolization, Therapeutic; Female; Hemorrhage; hepatocellular adenoma; Humans; Lesions; Liver; Liver cancer; Liver Neoplasms - surgery; Male; Malignancy; Middle Aged; Patients; retrospective review; Retrospective Studies; Risk perception; Tumors; Young Adult; hepatocellular adenoma; retrospective review
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.15648

Background Hepatocellular adenoma (HCA) is a rare benign liver tumour that may cause diagnostic and management dilemmas. This study describes the clinical and histopathological characteristics of patients who were treated for HCA in a tertiary referral hospital over a 17‐year period. Methods A retrospective review was performed of prospectively collected data of all patients treated for HCA within the Northern Upper GI Surgical unit between 2002 and 2018. Immunohistochemical β‐catenin expression was evaluated. Results Thirty‐two patients had histological or radiologically confirmed HCA. Twenty‐eight patients underwent 30 operations and four patients were treated conservatively. The median age of the operative group was 43 years (range 19–83) and most patients were female (95%). The median body mass index was 28.7 (range 20–51), and nine patients (33%) were obese. Seven patients (25%) had multifocal HCA. Evidence of prior bleed or rupture or a perceived risk of either a bleed or malignant change (i.e. tumours ≥50 mm) were the most common indications for resection. There were no perioperative mortalities. Nuclear expression of β‐catenin by immunohistochemical staining was negative in all cases and there was no malignancy identified in any of the resected lesions. Two patients required transarterial embolization and two patients required a second liver resection for residual HCA. Conclusion HCA is a rare lesion predominantly affecting females. Haemorrhage is seen frequently on imaging studies, occasionally requiring urgent angioembolization and/or surgical intervention. Malignant transformation and immunohistochemical β‐catenin expression are uncommon. HCA may be multifocal and residual tumours usually require ongoing surveillance and occasionally further intervention. Hepatocellular adenoma is a rare benign tumour of the liver posing many diagnostic and management dilemmas. This work reviews a single‐institution operative and non‐operative experience of patients with hepatocellular adenoma.