Hepatocellular adenoma natural history

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zahir Ali Shaikh, MD[2]

There is 30% bleeding risk for hepatocellular adenoma if left untreated. The natural course of hepatocellular adenoma after cessation of oral contraceptive use remains unclear, it may regress or remain stable in size. Complications include bleeding, rupture and malignant transformation. The prognosis is usually good after discontinuation of oral contraceptives, as it may regress. In cases where it does not regress after oral contraception withdrawal, surgery is the management of choice.

• The hepatocellular adenoma if left untreated, there is 30% bleeding risk.^[1]
• The natural course of hepatocellular adenoma after cessation of oral contraceptive use remains unclear, it may regress or remain stable in size.^[2]
• Obesity and metabolic syndrome may facilitate the progression of hepatocellular adenoma, therefore weight loss may help in stability or regression of the lesion.^[3]

• The complications of hepatocellular adenoma include;^{[4][5][6][7][8]}
• Bleeding and rupture
  • The presence of hepatocellular adenoma can be complicated by growth and rupture.
  • Bleeding in hepatocellular adenoma ranges from small subclinical bleed to life threatening intraperitoneal rupture, resulting in hemorrhagic shock requiring emergency care.
  • Bleeding and rupture in hepatocellular adenoma are associated with tumor size and use of oral contraceptives.
  • There is also increased risk of rupture in pregnancy because of increased hormone levels.
  • The risk of rupture does not seem to be associated with tumor number.
  • The risk of bleeding is directly correlated with size of tumor and > 5cm hepatocellular adenomas have a high risk of hemorrhage.
• Malignant transformation
  • The malignant transformation into hepatocellular carcinoma is a serious but rare complication of hepatocellular adenoma.
  • The specific risk factors for hepatocellular carcinoma include hepatocellular adenoma nodules with aberrant nuclear beta catenin expression. This subgroup seems overpresented in male patients.
  • Male sex and tumor size >5cm have been identified as risk factors associated with higher rate of malignant transformation.^[4]

• The prognosis is usually good for hepatocellular adenoma.
• When diagnosed, the discontinuation of oral contraception or androgen intake leads to regression of hepatocellular adenoma.
• In cases that do not regress after the withdrawal of oral contraception or androgen, surgical treatment is the management of choice.^[9]

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