Hepatocellular Adenoma
Content of This Page
1- Introduction
2- Pathophysiology
3- Symptoms
4- Stages of The Disease
5- Investigations
6- Treatment
7- What Should You Avoid
Introduction
Hepatocellular adenoma is a rare, benign liver tumour, mainly seen in young women.
Strongly linked to oral contraceptives, androgens, and anabolic steroids.
Often found incidentally on imaging; can cause abdominal pain or bleeding if large.
Risk of malignant transformation, especially in men.
Management includes stopping hormone use and surgical resection if:
≥5 cm (in women)
Any size in men
Rapid growth or risk of rupture
Pathophysiology
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HCA is a benign clonal proliferation of hepatocytes.
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Driven by hormonal factors such as oestrogens (oral contraceptives), androgens, and anabolic steroids.
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No associated fibrosis or inflammation.
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Risk of complications:
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Rupture and bleeding (especially if large or during pregnancy)
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Malignant transformation, particularly in men or with large tumours
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Symptoms
Often asymptomatic and found incidentally on imaging.
When symptomatic, patients may present with:
Right upper quadrant (RUQ) pain or discomfort
Abdominal mass (if the tumour is large)
Acute abdominal pain with hypotension (suggests tumour rupture and bleeding)
Risk of rupture is higher during pregnancy or with large tumours.
Stages of The Disease
1. Functional Classification (Implied Stages):
| Stage/Category | Description |
|---|---|
| Asymptomatic small HCA | Usually <5 cm; discovered incidentally on imaging; low risk |
| Large or growing HCA | ≥5 cm; increased risk of bleeding and potential for malignant transformation |
| Symptomatic HCA | Presents with pain or mass; may need intervention |
| Complicated HCA | Tumour rupture, haemorrhage, or malignant transformation to hepatocellular carcinoma |
Investigations
1. Imaging (Primary Diagnostic Tool)
Ultrasound
Often detects HCA incidentally
May appear as a well-defined lesion, but features are non-specific
CT or MRI
Preferred for characterisation and confirmation
MRI is particularly useful to distinguish HCA from other lesions like focal nodular hyperplasia (FNH)
May help identify exophytic growth or haemorrhage risk
2. Biopsy
Rarely needed unless imaging is inconclusive
Avoided if diagnosis is clear radiologically, especially due to bleeding risk
3. Hormonal and Risk Factor Review
Assess for history of:
Oral contraceptive or steroid use
Anabolic steroids
Pregnancy
These factors support the diagnosis and guide management (e.g. discontinuing hormones)
4. Monitoring
For lesions <5 cm: imaging follow-up to assess stability
For larger or atypical lesions: consider resection
Treatment
1. Withdrawal of Risk Factors
Stop oral contraceptives, anabolic steroids, or other hormone therapies
Can lead to regression of the tumour, especially if <5 cm
2. Surgical Resection
Indicated when:
Tumour is ≥5 cm (in women)
Any size in men (due to higher malignancy risk)
Rapid growth, symptoms, or bleeding
Resection reduces risks of rupture and malignant transformation
3. Conservative Monitoring
Suitable for:
Asymptomatic women
Lesions <5 cm
No concerning features
Requires regular imaging (MRI or CT) to monitor size and stability
4. Special Considerations
Pregnancy: Risk of tumour growth and rupture increases; monitor closely
Avoid liver biopsy unless necessary, due to bleeding risk
What Should You Avoid
1. Hormonal Medications
Avoid oral contraceptives, anabolic steroids, and other hormone-based therapies.
These stimulate tumour growth and may trigger complications.
2. Pregnancy Without Monitoring
Pregnancy can cause HCA growth or rupture.
Avoid unplanned pregnancy in patients with known HCA without specialist input.
Requires close imaging follow-up if pregnancy occurs.
3. Delayed Surgical Referral
Do not delay resection if:
Tumour is ≥5 cm
Present in men
Showing rapid growth or bleeding
Delay may increase the risk of rupture or malignancy
4. Percutaneous Biopsy (Routine Use)
Avoid routine biopsy due to risk of bleeding, especially in large or vascular tumours.
Imaging is usually sufficient for diagnosis.