Abstract
Hepatocellular adenoma (HCA) is a rare benign liver tumor that has been reported to occur particularly more often in women who use contraceptives. A 72-year-old woman with no history of using contraceptives presented to our hospital for further examination of a liver tumor. Contrast-enhanced computed tomography and gadoxetic acid-enhanced magnetic resonance imaging revealed a huge solitary hepatic tumor measuring 83 × 76 mm in segments 4, 5, and 8. The differential diagnoses were cholangiocarcinoma and mixed-type hepatocellular carcinoma. Percutaneous needle biopsies were performed twice, and no malignant components were found. Central bi-segmentectomy of the liver was successfully performed. Immunohistochemical staining showed that β-catenin was positive in the membrane of the tumor cells, while fatty acid-binding protein, glutamine synthetase, and amyloid A were negative. These results led to a diagnosis of HCA, hepatocyte nuclear factor-1α-inactivated subtype. The patient’s postoperative course was uneventful, and she developed no recurrence for 10 months after surgery. We experienced a rare case of benign HCA. Obtaining a correct preoperative diagnosis is sometimes difficult at the first evaluation. HCA should be considered as a differential diagnosis of liver tumors.
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Abbreviations
- HCA:
-
Hepatocellular adenoma
- HNF-1α:
-
Hepatocyte nuclear factor-1α
- CE-CT:
-
Contrast-enhanced computed tomography
- MRI:
-
Magnetic resonance imaging
References
Rooks JB, Ory HW, Ishak KG, et al. Epidemiology of hepatocellular adenoma. The role of oral contraceptive use. JAMA. 1979;242:644–8.
Reddy KR, Schiff ER. Approach to a liver mass. Seminars Liver Dis. 1993;13:423–35.
Sasaki M, Nakanuma Y. Overview of hepatocellular adenoma in Japan. Int J Hepatol. 2012;2012:648131.
Stoot JH, van der Linden E, Terpstra OT, et al. Life-saving therapy for haemorrhaging liver adenomas using selective arterial embolization. Br J Surg. 2007;94:1249–53.
Terkivatan T, de Wilt JH, de Man RA, et al. Treatment of ruptured hepatocellular adenoma. Br J Surg. 2001;88:207–9.
Chuang WY, Chen TC, Hsu HL, et al. Liver cell adenoma with concomitant hepatocellular carcinoma: report of two cases. J Formos Med Assoc. 2002;101:798–802.
Dokmak S, Paradis V, Vilgrain V, et al. A single-center surgical experience of 122 patients with single and multiple hepatocellular adenomas. Gastroenterology. 2009;137:1698–705.
Micchelli ST, Vivekanandan P, Boitnott JK, et al. Malignant transformation of hepatic adenomas. Mod Pathol. 2008;21:491–7.
Laurent A, Dokmak S, Nault JC, et al. European experience of 573 liver resections for hepatocellular adenoma: a cross-sectional study by the AFC-HCA-2013 study group. HPB (Oxford). 2016;18:748–55.
Bioulac-Sage P, Taouji S, Possenti L, et al. Hepatocellular adenoma subtypes: the impact of overweight and obesity. Liver Int. 2012;32:1217–21.
Dokmak S, Belghiti J. Will weight loss become a future treatment of hepatocellular adenoma in obese patients? Liver Int. 2015;35:2228–32.
Bunchorntavakul C, Bahirwani R, Drazek D, et al. Clinical features and natural history of hepatocellular adenomas: the impact of obesity. Aliment Pharmacol Ther. 2011;34:664–74.
Katabathina VS, Menias CO, Shanbhogue AK, et al. Genetics and imaging of hepatocellular adenomas: 2011 update. Radiographics. 2011;31:1529–43.
Mounajjed T. Hepatocellular adenoma and focal nodular hyperplasia. Clin Liver Dis (Hoboken). 2021;17:244–8.
Stoot JH, Coelen RJ, De Jong MC, et al. Malignant transformation of hepatocellular adenomas into hepatocellular carcinomas: a systematic review including more than 1600 adenoma cases. HPB (Oxford). 2010;12:509–22.
Cho SW, Marsh JW, Steel J, et al. Surgical management of hepatocellular adenoma: take it or leave it? Ann Surg Oncol. 2008;15:2795–803.
Kudo M. Malignant transformation of hepatocellular adenoma: how frequently does it happen? Liver Cancer. 2015;4:1–5.
Kim DH, Kim SU, Nam DH, et al. A case of hepatocellular carcinoma within hepatocellular adenoma in a non-cirrhotic male. Korean J Intern Med. 2009;24:147–52.
Khaoudy I, Rebibo L, Regimbeau JM. Is bariatric surgery a potential new treatment for large inflammatory hepatocellular adenomas in obese patients? Surg Obes Relat Dis. 2018;14:535–8.
Bioulac-Sage P, Laumonier H, Couchy G, et al. Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience. Hepatology. 2009;50:481–9.
Bioulac-Sage P, Balabaud C, Zucman-Rossi J. Subtype classification of hepatocellular adenoma. Dig Surg. 2010;27:39–45.
Laumonier H, Bioulac-Sage P, Laurent C, et al. Hepatocellular adenomas: magnetic resonance imaging features as a function of molecular pathological classification. Hepatology. 2008;48:808–18.
Bioulac-Sage P, Cubel G, Taouji S, et al. Immunohistochemical markers on needle biopsies are helpful for the diagnosis of focal nodular hyperplasia and hepatocellular adenoma subtypes. Am J Surg Pathol. 2012;36:1691–9.
Acknowledgements
We would like to thank all staff members involved in the patient’s care. We also thank Angela Morben, DVM, ELS, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.
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HT, KH, HI, DT, AG, SF, KO, JH, TW, and YK participated in the diagnosis and treatment of the patient and wrote the first draft of this manuscript. All authors read and approved the final manuscript.
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Tomihara, H., Hashimoto, K., Ishikawa, H. et al. Successful resection of a huge hepatocellular adenoma. Clin J Gastroenterol 14, 1544–1549 (2021). https://doi.org/10.1007/s12328-021-01486-4
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DOI: https://doi.org/10.1007/s12328-021-01486-4