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9.6 Adenoma
Presents in women using oral contraception.
The liver cell adenoma occurs mainly in young women using oral contraception. Very rarely it is provoked by the intake of anabolic steroids in men. The diagnosis is made by the typical characteristics on CT or MRI scan. The lesion does not contain bile ducts and porat fields. Recently, different histological types have been distinguished. Lesions containing beta-catenin mutation are precancerous.
Liver adenoma can be complicated by bleeding. Rarely, it can degenerate if it is larger than five centimeters. When the diagnosis is made, oral contraception must be stopped. Then one can wait six to twelve months. If the lesion is still larger than five centimeters after this period, it must be resected. In men, the chance of complications is very high and surgery must always be performed.
Very rarely, more than ten adenomas can occur (polyadenomatosis). This is sometimes accompanied by liver steatosis in young women. The approach is similar to the solitary adenoma. In case of overweight, the patient is advised to lose weight.
Liver adenoma
Hepatocellular adenoma (HCA) is a rare and benign liver tumor that affects predominantly young and middle-aged women, especially between 30–40 years old. Liver adenomatosis (LA) is defined as the presence of 10 or more HCA. There are authors that report eight different subtypes of HCA, that correlates with clinical and histopathological features, being the inflammatory subtype the most common. Management of patients with LA should be based on the size of the largest tumor, as clinical presentation and risk of bleeding or malignancy do not differ between patients with single or multiple HCAs. However, even with biopsy, there is a risk of missampling, raising concern about the real risk of bleeding and malignant potential in patients with different subtypes coexisting in the same liver.
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