Journal article
Hepatic adenoma: evolution of a more individualized treatment approach
Journal of gastrointestinal surgery, Vol.28(6), pp.975-982
06/01/2024
DOI: 10.1016/j.gassur.2024.03.010
PMID: 38521190
Abstract
Hepatic adenomas (HAs) are benign, solid liver lesions, which carry a risk of hemorrhage and malignant transformation. This review article highlights the advances in the diagnosis and management of HAs.
A comprehensive review was performed using MEDLINE/PubMed and Web of Science databases with a search period ending on September 30, 2023. Using PubMed, the terms “hepatocellular,” “hepatic,” and “adenoma” were searched.
HA has been classified into at least 8 subtypes based on molecular pathology, each exhibiting unique histopathologic features, clinical considerations, and risk of malignant transformation. The most common subtype is inflammatory HA, followed by hepatocyte nuclear factor 1α–inactivated HA, β-catenin exon 3-mutated HA (βex3-HA), β-catenin exon 7- or 8-mutated HA, sonic hedgehog HA, and unclassified HA. Magnetic resonance imaging is the best imaging method for diagnosis and can distinguish among HA subtypes based on fat and telangiectasia pathologic characteristics. The risk of malignant transformation varies among molecular subtypes, ranging from <1% to approximately 50%. Up to 42% of HAs present with spontaneous intratumoral hemorrhage and peritoneal hemorrhage. In general, only 15% to 20% of patients require surgery. HA larger than 5 cm are more likely to be complicated by bleeding and malignant transformation, regardless of subtype, and should generally be resected. In particular, βex3-HA carries a high risk of malignant transformation and can be considered a true precancerous lesion.
The management of HAs is based on a multidisciplinary approach. Clinical decision-making should integrate information on gender, tumor size, and HA subtyping. In the future, patients with HA will benefit from novel medical therapies tailored to the individual molecular subtypes.
Details
- Title: Subtitle
- Hepatic adenoma: evolution of a more individualized treatment approach
- Creators
- Hassan Aziz - University of IowaPatrick W. Underwood - The Ohio State University Wexner Medical CenterMatthew D. Gosse - University of IowaShadi Afyouni - University of Colorado DenverIhab Kamel - University of Colorado DenverTimothy M. Pawlik - The Ohio State University Wexner Medical Center
- Resource Type
- Journal article
- Publication Details
- Journal of gastrointestinal surgery, Vol.28(6), pp.975-982
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.gassur.2024.03.010
- PMID
- 38521190
- ISSN
- 1091-255X
- eISSN
- 1873-4626
- Language
- English
- Date published
- 06/01/2024
- Academic Unit
- Pathology; Surgery
- Record Identifier
- 9984640615802771
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