Hepatocellular adenoma

Hepatocellular adenoma (HCA), also known as hepatic adenoma or liver cell adenoma, is a rare benign tumor of the liver arising from hepatocytes. It predominantly affects women of reproductive age and is strongly associated with the use of oral contraceptive pills (OCPs) and other estrogen-containing hormonal therapies. Other risk factors include anabolic steroid use, glycogen storage diseases (particularly types I and III), obesity, and metabolic syndrome. The tumor primarily affects the liver and can range from a single lesion to multiple adenomas; when ten or more lesions are present, the condition is termed hepatic adenomatosis. Hepatocellular adenomas are classified into several molecular subtypes based on their genetic and pathological features: HNF1A-inactivated (H-HCA), inflammatory (I-HCA), beta-catenin-activated (b-HCA), and unclassified. This subtyping has important clinical implications, as beta-catenin-activated adenomas carry a higher risk of malignant transformation to hepatocellular carcinoma, while HNF1A-inactivated adenomas are generally considered lower risk. Many patients are asymptomatic, with the adenoma discovered incidentally on imaging. However, key symptoms can include right upper quadrant abdominal pain, a palpable abdominal mass, and in some cases, life-threatening intra-abdominal hemorrhage due to spontaneous rupture of the tumor. Management of hepatocellular adenoma depends on size, subtype, symptoms, and risk of complications. The first-line approach includes discontinuation of oral contraceptives or other hormonal agents, which may lead to tumor regression. Surgical resection is generally recommended for adenomas larger than 5 cm due to the increased risk of hemorrhage and malignant transformation, and for all beta-catenin-activated subtypes regardless of size. For smaller, stable lesions, surveillance with periodic imaging (MRI) is often employed. In cases of hepatic adenomatosis or recurrent disease, liver transplantation may rarely be considered. Embolization may be used in acute hemorrhagic settings. Regular follow-up is essential to monitor for growth or malignant transformation.

Data sourced from FDA regulatory filings and ClinicalTrials.gov. Updated periodically.

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