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Introdução: O trabalho objetiva avaliar o perfil epidemiológico dos pacientes operados por adenoma hepático e os fatores de influência nas diferentes apresentações clínicas. Métodos: Estudo transversal descritivo com 21 pacientes operados por adenoma hepático. Dados de prontuário e laudos anatomopatológicos foram revisados a fim de estudar a relação entre perfil dos pacientes, apresentação clínica e características do tumor. Resultados: Sexo feminino foi predominante na amostra. A idade média dos pacientes foi de 32 anos e o IMC médio 25,9. Uso de anticoncepcional oral foi relatado em 93% dos casos, sendo 13 anos o tempo médio de uso. A presença de comorbidades teve associação com adenomas de maior tamanho, e diabetes mellitus foi doença mais frequente associada a este tumor. Houve associação clínica entre tamanho do adenoma e sintomatologia: pacientes com sinais e sintomas mais pronunciados apresentaram lesões de tamanho médio superior em comparação aos pacientes com sintomas inespecíficos ou ausentes. Conclusão: Os fatores já conhecidos associados ao Adenoma Hepático envolvem o sexo feminino, uso de contraceptivo oral de longa data, doenças do armazenamento do glicogênio, uso de anabolizantes e, menos comumente, gestação e diabetes mellitus. Neste trabalho evidenciamos o diabetes mellitus como a comorbidade mais frequente entre os pacientes com diagnóstico de Adenoma Hepático, relacionando-se a adenomas de maior tamanho na amostra deste estudo, o que sugere possível associação do diabetes mellitus na gênese dos adenomas hepáticos e também no prognóstico, visto que lesões maiores representam risco aumentado de complicações.
Introduction: This work aims to evaluate the epidemiological profile of patients who underwent surgery for liver adenoma and the factors that could influence different clinical presentations. Methods: Descriptive cross-sectional study with 21 patients with liver adenoma who underwent surgery. Medical records and pathological reports were reviewed to study the connection between patients' profile, clinical presentation, and features of the tumor. Results: Female sex predominated in the sample. The mean age of patients was 32 years and the mean BMI was 25.9. The use of oral contraceptives was reported in 93% of the cases, with an average usage time of 13 years. The presence of comorbidities was associated with larger adenomas, and diabetes mellitus was the most frequent comorbidity co-existing with this tumor. Clinical association between the size of adenomas and symptoms was identified: patients with more pronounced signs and symptoms had larger lesions compared with patients with nonspecific or absent symptoms. Conclusion: The known factors associated with Hepatic Adenoma involve female sex, long-term use of oral contraceptives, glycogen storage diseases, use of anabolic steroids, and, less commonly, pregnancy and diabetes mellitus. In this study, we highlight diabetes mellitus as the most frequent comorbidity among patients diagnosed with Hepatic Adenoma, relating to larger adenomas in this study sample, which suggests a possible association of diabetes mellitus in the genesis of liver adenomas and in the prognosis, since larger lesions represent an increased risk of complications.
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Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Adenoma, Liver Cell/surgery , Adenoma, Liver Cell/epidemiology , Liver Neoplasms/epidemiologyABSTRACT
Objective:To explore the diagnosis and treatment of hepatocellular adenoma.Methods:The clinical data of 23 hepatocellular adenoma patients admitted to the Affiliated Hospital of Qingdao University from May 2013 to May 2020 were retrospectively analyzed.Results:Fifteen patients were female, the age ranged from 21 to 60. The maximum tumor diameter was from 2.5 cm to 15 cm.Most patients (15/23) were asymptomatic. There were 20 cases (87%) with single lesion and 3 cases (13%) with multiple lesions. Contrast-enhanced CT and MRI showed enhancement in the arterial phase, and de-enhancement in the portal phase as well as in the delayed phase. All cases underwent tumor resection. Hepatocellular adenoma was confirmed by pathology with partial canceration in one case and intratumoral hemorrhage in two cases. Sixteen cases were misdiagnosed preoperatively, 20 were followed up with the median follow-up time of 36 months. Recurrence was not found.Conclusion:Hepatocellular adenoma is uncommon and often misdiagnosed. Preoperative diagnosis is dependent on MRI.Given the fact of high rate misdiagnosis and a tendency of canceration,resection is recommended.
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RESUMO - RACIONAL: As principais indicações das hepatectomias video-laparoscópicas (HVL), inicialmente, eram nas lesões hepáticas benignas. À medida que a HVL se tornou mais popular, as indicações de doenças malignas superaram as de doenças benignas. Este estudo teve como objetivo discutir as indicações e resultados da HVL para o tratamento de tumores hepáticos benignos. MÉTODOS: De 445 HVL realizadas em um único centro, 100 (22,4%) foram para tumores benignos. Os autores discutem as indicações para ressecção e apresentam seus resultados perioperatórios. RESULTADOS: No total, 100 pacientes com tumores benignos foram avaliados, a saber: 66 casos de adenomas hepatocelulares; 14 de neoplasia mucinosa biliar; 13 de hiperplasia nodular focal; 4 de angiomiolipomas; e 3 de hemangiomas. O tamanho médio das lesões foi de 7,6 cm (3,1 a 19,6 cm). A taxa de morbidade total foi de 19%, sendo 9% classificados como Clavien-Dindo 3 ou 4 e não foi observada mortalidade. CONCLUSÃO: A HVL para tumores hepáticos benignos é segura e apresenta excelentes resultados. No entanto, as indicações para cirurgia são cada vez mais restritas, não sendo recomendável indicar a ressecção somente por se tratar de procedimento minimamente invasivo.
ABSTRACT - BACKGROUND: The main indications of the use of laparoscopic liver surgery (LLS), in the early days, were benign liver lesions. As LLS became more popular, indications for malignant diseases outnumbered those for benign ones. This study aims to rule out the indications and results of LLS for the treatment of benign liver tumors. METHODS: Out of 445 LLS performed in a single center, 100 (22.4%) were for benign tumors. The authors discuss the indications for resection and present their perioperative results. RESULTS: In total, 100 patients with benign tumors were evaluated. Specifically, these were as follows: 66 cases of hepatocellular adenomas; 14 cases of biliary mucinous neoplasm; 13 cases of focal nodular hyperplasia; 4 cases of angiomyolipomas; and 3 cases of hemangiomas with a mean size of 7.6 cm (ranging from 3.1 to 19.6 cm). The total morbidity rate was 19%, with 9% classified as Clavien-Dindo grades 3 or 4. No mortality was observed. CONCLUSION: LLS for benign liver tumors is safe and presents excellent results. However, indications for resection are increasingly restricted and should not be performed just because it is a minimally invasive procedure.
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Humans , Laparoscopy , Liver Neoplasms/surgery , Retrospective Studies , HepatectomyABSTRACT
Hepatocellular adenoma is a rare type of benign tumor in the liver. It has high risk of rupture and low risk of malignant transform. Recently the incidence of hepatocellular adenoma malignant transforming has been increasing. The malignant progress of hepatocellular adenoma develop to hepatocellular carcinoma has the transition state. This course not only relyes on the CTNNB1 gene exon 3 mutations, but also depends on TERT gene promoter mutation. This article will elaborate the hepatocellular adenoma malignant transforming in molecule mechanism, pathological diagnosis and therapies.
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Objective To evaluate the clinical value of CT combined with MRI in the qualitative diagnosis of hepatic lesions.Methods From August 2015 to March 2018,100 patients with liver diseases were selected from Zhoushan Hospital.CT,MRI and combined examination were performed respectively.The results of diagnosis of liver diseases in three different ways were compared and analyzed.Results A total of 96 lesions were detected by CT,the detectable rate was 88.89% ,97 lesions were detected by MRI,and the detectable rate was 89.81%. A total of 105 lesions were detected by CT and MRI,and the detectable rate was 97.22%.The detection rate and number of detected lesions of combined test were significantly higher than those of single test (χ2 =8.25,6.22,all P<0.05), but there were no statistically significant differences in the detection rate and the number of lesions between CT and MRI (all P>0.05).Conclusion The diagnosis of benign and malignant lesions by the combination of CT and MRI is very good.The diagnostic effect is relatively small and the safety factor is high.It is worth widely used in clinical diagnosis of patients.
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Objective@#To evaluate the clinical value of CT combined with MRI in the qualitative diagnosis of hepatic lesions.@*Methods@#From August 2015 to March 2018, 100 patients with liver diseases were selected from Zhoushan Hospital.CT, MRI and combined examination were performed respectively.The results of diagnosis of liver diseases in three different ways were compared and analyzed.@*Results@#A total of 96 lesions were detected by CT, the detectable rate was 88.89%, 97 lesions were detected by MRI, and the detectable rate was 89.81%.A total of 105 lesions were detected by CT and MRI, and the detectable rate was 97.22%.The detection rate and number of detected lesions of combined test were significantly higher than those of single test (χ2=8.25, 6.22, all P<0.05), but there were no statistically significant differences in the detection rate and the number of lesions between CT and MRI (all P>0.05).@*Conclusion@#The diagnosis of benign and malignant lesions by the combination of CT and MRI is very good.The diagnostic effect is relatively small and the safety factor is high.It is worth widely used in clinical diagnosis of patients.
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Hepatocellular adenoma is a rare type of benign tumor in the liver. It has high risk of rupture and low risk of malignant transform. Recently the incidence of hepatocellular adenoma malignant transforming has been increasing. The malignant progress of hepatocellular adenoma develop to hepatocellular carcinoma has the transition state. This course not only relyes on the CTNNB1 gene exon 3 mutations, but also depends on TERT gene promoter mutation. This article will elaborate the hepatocellular adenoma malignant transforming in molecule mechanism, pathological diagnosis and therapies.
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Hepatocellular adenoma (HCA) is the most common type of benign liver tumor, and its major complication is malignant transformation to hepatocellular carcinoma (HCC). Here, we report a case of HCC arising in HCA with bone marrow metaplasia in a 24-year-old Korean woman who presented with abdominal discomfort. A huge liver mass was found on abdominal ultrasonography. She underwent surgical hepatic resection, and the resected specimen was entirely involved by a 20-cm-sized tumor. Histological review revealed a well differentiated HCC arising from inflammatory HCA with β-catenin nuclear positivity and bone marrow metaplasia that contained hematopoietic cells. This case was unique because malignant transformation, inflammatory type HCA, β-catenin nuclear staining, and bone marrow metaplasia were simultaneously observed. Additionally, it should be noted that a large HCA with β-catenin activation can undergo malignant transformation and should be surgically resected in a timely manner.
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Female , Humans , Young Adult , Adenoma, Liver Cell , Bone Marrow , Carcinoma, Hepatocellular , Liver , Metaplasia , UltrasonographyABSTRACT
Hepatocellular adenomas (HCA) are rare benign tumors of the liver, and according to the differences in molecular genetics and pathology, HCA is categorized as inflammatory hepatocellular adenoma (IHCA), HCA with hepatocyte nuclear factor 1-alpha mutation (H-HCA), HCA with β-catenin mutation (β-HCA), and an undefined type. The incidence of these four types is 40%-50%, 30%-40%, 10%-15%, and 10%, respectively. In these four types of HCA, β-HCA has high risk of bleeding and malignant transformation, while H-HCA is not likely to show malignant transformation. Therefore, the accurate diagnosis of these types of HCA is very important. This article introduces the radiological features of these types of HCA on conventional MRI and hepatocyte-targeted contrast-enhanced scan and compares these findings with other types of liver solid tumors such as focal nodular hyperplasia, nodular regenerative hyperplasia, liver cancer in non-cirrhotic patients, and fibrolamellar carcinoma of the liver. It is pointed out that MRI and hepatocyte-targeted contrast agents play an important role in the diagnosis and differentiation of HCA.
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Objetivos: El enfoque terapéutico de los adenomas ha cambiado en los últimos años, en especial por las posibilidades de caracterización por medio de las imágenes diagnósticas, principalmente la resonancia magnética (RM), que en la mayoría de los casos ha permitido una aproximación al tipo de adenoma. Métodos: Se realizó una revisión de la literatura reciente con el fin de describir las características imagenológicas de los tipos de adenomas, en las diferentes técnicas de imágenes, con principal énfasis en los hallazgos imagenológicos en resonancia magnética, lo cual permite diferenciar entre los subtipos histológicos de adenomas y ayuda a orientar el manejo médico o quirúrgico. Resultados: En la literatura se describe la adenomatosis hepática como una entidad frecuente en mujeres, de características imagenológicas atípicas. Además, se mencionan las características de los hallazgos por RM y su correlación con los tipos de adenomas, variedad esteatósica, peliótica y mixta. Conclusión: De acuerdo con la clasificación basada en las características genéticas, histopatológicas e imagenológicas de los diferentes subtipos de AHC y según la sintomatología, se podría determinar la historia natural y definir el pronóstico y las opciones terapéuticas o de seguimiento imagenológico.
Objective: The therapeutic approach of adenomas has changed in recent years, especially because of the possibilities for characterization by means of diagnostic imaging methods, mainly magnetic resonance imaging, which allowed us, in most cases, to approach the type of adenoma. Methods: A review of the recent literature was conducted in order to describe the characteristic imaging features of the types of adenomas in the different imaging techniques, with an emphasis on MRI, which allows differentiation between histologic subtypes of adenomas. In addition, it also helps guide medical or surgical management. Results: In the literature, we described hepatic adenomatosis as an entity which is frequently found in women, with atypical imaging features. In addition, we mentioned the characteristics of MRI findings and their correlation with the types of adenomas, inflammatory, steatosic, ß-catenin mutated and mixed. Conclusion: According to the classification based on genetic, histopathological and imaging features of the different subtypes of AHC, we could determine the natural history, define prognosis and the therapeutic options or imaging follow-up.
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Humans , Adenoma, Liver Cell , Magnetic Resonance Imaging , Adenoma, Liver CellABSTRACT
Hepatocellular adenoma (HCA) is an uncommon benign hepatic tumor, and the use of oral contraceptives is known to contribute to the development of HCA. Recently, a genotype and phenotype classification system for HCA was suggested, and malignant transformation to hepatocellular carcinoma (HCC) was shown to be strongly associated with activating mutations in beta-catenin. Here, we report three cases of HCA in Korean patients: 7-cm, inflammatory and beta-catenin-activated HCA with HCC transformation in a 46-year-old man; 13-cm, beta-catenin-activated HCA with cytological atypia in a 23-year-old woman; and 10-cm, pigmented, inflammatory and beta-catenin-activated HCA in a 36-year-old man. All cases exhibited the nuclear expression of beta-catenin and diffuse cytoplasmic expression of glutamine synthetase upon immunohistochemical staining. All tumors were completely resected, and the patients were followed for 3 to 6 years with no evidence of local recurrence or metastasis.
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Adult , Female , Humans , Male , Middle Aged , Young Adult , Carcinoma, Hepatocellular/metabolism , Liver Neoplasms/metabolism , Republic of Korea , beta Catenin/metabolismABSTRACT
BACKGROUND: Hepatocellular adenoma (HCA) is a rare benign tumor of the liver. A subtype classification of HCA (hepatocyte nuclear factor 1alpha [HNF1alpha]-mutated, beta-catenin-mutated HCA, inflammatory HCA, and unclassified HCA) has recently been established based on a single institutional review of a HCA series by the Bordeaux group. METHODS: We used histologic and immunohistochemical parameters to classify and evaluate eight cases from our institution. We evaluated the new classification method and analyzed correlations between our results and those of other reports. RESULTS: Seven of our eight cases showed histologic and immunohistochemical results consistent with previous reports. However, one case showed overlapping histologic features, as previously described by the Bordeaux group. Four cases showed glutamine synthetase immunohistochemical staining inconsistent with their classification, indicating that glutamine synthetase staining may not be diagnostic for beta-catenin-mutated HCA. HNF1alpha-mutated HCA may be indicated by the absence of liver fatty acid binding protein expression. Detection of amyloid A may indicate inflammatory HCA. HCA with no mutation in the HNF1alpha or beta-catenin genes and no inflammatory protein expression is categorized as unclassified HCA. CONCLUSIONS: Although the new classification is now generally accepted, validation through follow-up studies is necessary.
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Adenoma, Liver Cell , Amyloid , beta Catenin , Fatty Acid-Binding Proteins , Glutamate-Ammonia Ligase , Hepatocyte Nuclear Factor 1-alpha , Liver , Serum Amyloid A ProteinABSTRACT
ObjectiveTo summarize our experience on the diagnosis and surgical treatment of hepatocellular adenoma (HCA).MethodsClinical data of 47 HCA cases managed from 1989 to 2009 were analyzed retrospectively. ResultsAll were single lesions.Preoperative correct diagnosis was established in only 7 cases ( 14.9％ ).Tentative malignant space-occupying lesions was diagnosed in other 40 cases (85.1％),including hepatocellular carcinoma in 11 cases,liver hemangioma in 10 cases,liver focal nodular hyperplasia in 14 cases and miscellaneous in the remaining 5 cases.Local resection,segmental hepatectomy,hepatic lobectomy and hemiheptectomy were performed according to the size and location of the lesions.To prevent recurrence or malignant transformation,not less than 1.0 cm safe margin was allowed in all cases.Final diagnosis was made by fast frozen pathology or postoperative pathology.Postoperatively 45 cases were followed up to 6 years without recurrence.ConclusionsPreoperative misdiagnosis of HCA is common.Surgical resection is the only effective treatment,and the prognosis of HCA is favorable.
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Objective Focal nodular hyperplasia(FNH) is composed of multiple hyperplastic liver cell nodules,but its pathogenesis has not been elucidated. Foci (FAH) or nodules of altered hepatocytes (NAH) are precursors of hepatocellular adenoma (HCA) and carcinoma.This study aimed at identifying FAH and NAH from FNH and evaluating their role in FNH development.Methods 6 FNH lesions from 5 patients and 10 HCA from 9 patients were examined histologically,and expression levels of CD_(34) cytokeratin 19(CKl9) and Ki-67 antigen were demonstrated immunohistochemicailly.Proliferative activity was evaluated by Ki-67 antigen-labeling indices(Ki-67 LI).Results Multiple FAH and NAH were identified in all of the 6 FNH lesions. Whiie micmvasculatures were demonstrated by CD_(34) immunoreactivity in both HCA and FNH,their density and distribution were different in these two lesions,being diffuse in HCA and focal or nodular,mainly within NAH.CKl9 expression Was found in FNH,localized in ductal and ductular cells,but not within NAH and HCA.Average Ki.67 LI of 73 NAH(2.8%) was shown to be higher than that of the whole FNH lesions (0.6%),and had no statistieal difference comparable to that of HCA(1.8%).Conclusion Muhiple NAH are present in all classical FNH lesions.Unlike the surrounding parenchyma,NAH lesions are more proliferative and equipped with CD_(34)-positive microvasculatures as in HCA.
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Objective To retrospectively analyze CT and MR appearances of hepatic adenoma,and to study the causes of misdiagnosis with review of relative literatures.Methods CT and MRI data of 8 patients with pathologically confirmed hepatic adenoma were retrospectively analyzed.Pre-and post-contrast tri-phase (arterial,portal venous and delayed) CT scans and routine MR .scan were performed in all 8 patients,and proton magnetic resonance spectroscopy (~1H-MRS) was performed in 2 patients.Results Typical demonstrations were found in 4 patients who were correctly diagnosed.Among the others with atypical findings,3 patients were misdiagnosed as liver cancer and 1 as focal nodular hyperplasia (FNH) .The ~1H-MRS curves of 2 adenoma tumor showed that the peak of choline of tumor tissue had no significant difference comparing with that of normal liver tissue around the tumor tissue.Conclusion CT and MRI findings of hepatic adenomas have some characteristics,but atypical manifestations lead to misdiagnose.~1H-MRS may be helpful for the differential diagnosis of hepatic adenoma.
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Objective To probe the characteristic ultrasonic appearances of hepatic adenoma.Methods The appearances of color Doppler flow imaging(CDFI)and contrast-enhanced ultrasound(CEUS)in 10 cases of hepatic adenoma were analyzed.Results Rich blood flow signals were found in all the hepatic adenoma lesions on CDFI.Large blood flow signals were detected in the periphery of all tumors.On CEUS,peritumoral feeding vessels displayed in early arterial phase and homogeneous enhancement in arterial phase was observed in all the 4 cases.The tumor capsule was enhanced continuously in all cases.One case with isoechoic enhancement in delayed phase was found the contrast agent wash out in portal phase.The other 3 cases showed the‘fast-in and slow-out'appearance.which was iso-echoic enhancement in portal phase and slightly hyperechoic enhancement in delayed phase.Conclusions The rich blood flow signals,early displaying of peritumoral feeding vessels,homogeneous enhancement in the arterial phase and continuously enhanced tumor capsule on CEUS are the distinctive appearances of hepatic adenoma.
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Objective:To evaluate the accuracy and ch aracteristics of combined use of 99Tcm-sulfur colloid (SC)and 9 9Tcm-diethyliminodiacetic acid (EHIDA)imaging on the diagnosis of hepat ic adenoma (HA). Methods:8 patients with HA were involved in this study.All of them were studied by nuclear medicine (NM)with dual-radiopharmaceuticals.The 99 Tcm-SC imaging was perfomed first ,then the 99Tcm-EHIDA im aging two days later,and the ratios between lesions and normal liver tissue(L/N) were calculated in terms of different counts within the same size regions of int erest (ROI) in different phases(30min,1h and 2h respectively).Some of the cases were also analysed by CT and/or MRI within one week before the operations. Results:All of the cases were submitted to surgical treatment and c onfirmed diagnosis of HA by pathology. For HA, scintigrahy presented a accuracy of 100%(8/8),which was higher than that of CT and MRI comparatively.For 99 Tcm-EHIDA imaging,there were significant differences in L/N ratios among different phases(30min,1h and 2h). Conclusion:The results show that radionuclide imaging proved to be a safe,invasive and effcetive method on the diagnosis and differential diagnosis of HA,especially ,when CT and/or MRI findings are not typical.
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Objective To describe the US, CT, and MR imaging findings and diagnosis of hepatic adenomas. Methods The comprehensive imaging features in 6 patients with 6 hepatic adenomas confirmed pathologically were reviewed retrospectively and correlated with pathologic findings. Results One case was diagnosed correctly, four cases were mistaken for hepatocellular carcinomas (HCC), and one case was mistaken for focal nodular hyperplasia. US: six lesions were hypoechoic with hypohalo in four lesions, and there was low velocity arterial and venous flow within the six lesions. CT: six lesions were hypodense with pseudocapsule in four lesions, and the four lesions showed slight enhancement during arterial and portal venous phases, and one lesion showed moderate enhancement during arterial phase and slight enhancement during portal venous phase. MRI: six lesions had heterogeneously high signal intensity on T 1WI and T 2WI, and the high intensity on T 1WI remained unchanged after using fat saturation. Two lesions showed strong enhancement during arterial phase and slight enhancement during portal venous and delayed phases, and three lesions showed slight enhancement during arterial, portal venous, and delayed phases. Pseudocapsule detected in six lesions showed slight enhancement on portal venous or delayed phases. Conclusion The comprehensive imaging findings of hepatic adenomas were nonspecific. The presence of pseudocapsule, heterogeneous high signal intensity on T 1WI, and the high intensity remained unchanged after using fat saturation may help make a correct diagnosis of hepatic adenoma.
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To study the clinical and pathological features of hepatocellular adenomas.History and comprehensive imaging features in 6 patients with confirmed hepatocellular adenomas were reviewed retrospectively and correlated with pathological findings.The results showed that all six patients had solitary adenomas. Of the 6 patients, 4 were men and 2 were women. The diameter of tumors ranged from 4 to 11 centimeters, with an average of 8.5 centimeters. All the adenomas were hypervascular, and were nearly isoattenuating to normal liver on nonenhanced, portal vein period and delayed images except for areas of necrosis, hemorrhage, or focal fatty degeneration. Six lesions showed heterogeneously high signal intensity on T1 weighted images of MRI. All tumors were resected completely, and there were no serious complications and death. It suggested that these tumors may have some common features on CT and MRI images that should allow us to improve our diagnostic ability, if we could contrast imaging features with pathological characters. The surgical operation is effective.