Hepatic (Liver) Adenoma Formation and Treatment

Hepatic adenoma is an uncommon type of non-cancerous tumor that forms in the liver, usually occurring in younger women with a history of oral birth control use. People often find out they have one when they get imaging tests like ultrasounds, magnetic resonance imaging scans (MRIs), or computed tomography (CT) scans for other health reasons.

About 50% of the time, these tumors don’t cause any symptoms, so many people don’t even realize they have one until it shows up on a scan. Even though hepatic adenomas are benign, they can still cause problems, like bursting or becoming cancerous.

Symptoms

Hepatic adenomas often do not cause symptoms, so they can go unnoticed for long periods. However, if they grow large enough or if complications arise, some individuals may experience:

• Mild to severe abdominal pain in the upper right quadrant of the abdomen
• Bloating

In rare cases, adenomas can rupture, causing symptoms like:

• Severe abdominal pain
• Vomiting, often with blood
• Blood in stool
• Lightheadedness

Hepatic Adenoma and Birth Control: What’s the Link?

Research has shown a strong association between the development of hepatic adenomas and the use of hormonal contraceptives, particularly those containing higher doses of estrogen. In addition, stopping the oral contraceptive often leads to tumor regression.

Tumor Formation

Research has shown that using estrogen over a long period can increase the risk of developing liver tumors, including hepatic adenomas.

There are three molecular pathways involved in the development of hepatocellular adenoma:

• HNF1α Inactivation: HNF1α is like a “control switch” for liver cells. When this switch is turned off (inactivated), the liver cells can grow too much and become abnormal, forming a tumor.
• β-Catenin activation: In this pathway, a protein called β-catenin becomes overactive. This can happen due to mutations in the gene that codes for β-catenin. When β-catenin is overly active, it promotes cell growth and division, contributing to tumor formation.
• Inflammatory activation: This pathway is associated with inflammation in the liver, often linked to conditions like obesity and excessive alcohol consumption. Inflammation can lead to changes in liver cell behavior, increasing the risk of tumor development.

Women who take oral contraceptives have a similar risk for all three types of hepatic adenomas. While there have been rare cases where a hepatic adenoma turned into a more severe cancer called hepatocellular carcinoma (HCC), studies have not found strong evidence linking the use of oral contraceptives to an increased risk of HCC.

Other Risk Factors

Aside from hormonal influences, several other factors may be associated with developing hepatic adenomas, including:

• Consuming too much alcohol
• Obesity
• Metabolic syndrome
• Using anabolic steroids

Awareness of these risk factors can help individuals and healthcare providers identify those who may benefit from regular monitoring.

Testing and Radiology Findings

When hepatic adenomas are suspected, imaging studies are crucial for diagnosis and evaluation. Here are the primary modalities used in the assessment of hepatic lesions:

• Ultrasound: Often the first imaging technique used, ultrasound can help visualize liver lesions, including hepatic adenomas. These tumors typically appear as well-defined, homogeneous masses.
• Magnetic resonance imaging (MRI): Magnetic resonance imaging (MRI) provides detailed images of liver lesions and helps differentiate hepatic adenomas from other types of tumors or lesions. Adenomas often show characteristic patterns, such as a hyperintense signal on T1 or T2-weighted images.
• Computed tomography (CT) scan: CT scans can provide additional information on the size and vascularity of the adenoma. Contrast-enhanced CT scans help evaluate the tumor’s characteristics and assess for potential complications, such as hemorrhage.

If a hepatic adenoma is diagnosed, additional imaging may be required to monitor its size and behavior over time. Regular imaging follow-ups can ensure that any changes are detected early.

Treatment

The management of hepatic adenomas largely depends on their size, symptoms, and the individual’s overall health. For hepatic adenomas that are smaller than 5 centimeters (cm) and linked to oral contraceptive use, healthcare providers usually take a careful approach. They may suggest stopping the birth control pills and regularly checking the tumor using imaging tests like ultrasounds or MRIs. Many times, this can help the tumor shrink over time.

During pregnancy, most small adenomas don’t change much, and women with these tumors are generally not discouraged from getting pregnant.

When Providers Consider Removal

Surgical intervention may be warranted under certain conditions, such as:

• Size: In women, the adenoma may be removed if the adenoma is larger than 5 cm. At this size, it may cause more serious problems.
• Suspicion of malignancy: If imaging raises concerns about the potential for cancer, surgical removal is often recommended to ensure accurate diagnosis and treatment.

Surgery to remove the adenoma is typically recommended for all men, no matter how big the tumor is. This is because men are more likely to have adenomas that can cause cancer. The surgery for removing the tumor is considered a safe and effective treatment. However, it will only be done if necessary since all surgery carries some risk.

The main surgical options for treating hepatic adenomas are:

• Laparoscopic resection: This minimally invasive technique involves removing the adenoma through small incisions. It typically results in quicker recovery and less postoperative pain.
• Open surgery: In cases where the adenoma is particularly large or complicated, open surgery may be necessary to ensure complete removal.

Transarterial embolization (TAE) is a medical procedure for treating hepatic adenomas when bleeding occurs inside the tumor. This procedure blocks blood flow to the tumor, which helps stop the bleeding. TAEs are usually performed within two to three days of the bleeding occurring, and it may be followed by surgery to remove the tumor if necessary.

Surgery Recovery

Recovery from surgery for hepatic adenoma can vary based on the individual’s overall health, the surgical technique used, and the size of the tumor. Here are some general recovery considerations:

• Hospital stay: Laparoscopic procedures typically require a shorter hospital stay (1–2 days) than open surgery (3–6 days).
• Activity limitations: Patients may need to limit physical activity for several weeks post-surgery to allow the liver to heal properly.

Statistics on Recurrence

The outlook for people with hepatocellular adenoma (HCA) is not well understood. Stopping oral contraceptives can sometimes shrink or heal the tumor. Surgical resection may significantly reduce the likelihood of recurrence.

In a study of 118 people who had surgery to remove hepatic adenomas, 8% had the tumor come back or get bigger. For the 10 patients whose tumors became cancerous, there were no signs of cancer returning after an average follow-up period of 78 months.

Summary

Hepatic adenomas are benign liver tumors primarily influenced by hormonal factors, particularly estrogen. While often asymptomatic, they can lead to significant complications, making awareness and monitoring critical. Early detection through imaging techniques such as ultrasound, MRI, and CT scans can facilitate timely intervention. Treatment options, including surgical removal, may be necessary based on the size of the adenoma and the symptoms experienced.

If you or a loved one has been diagnosed with a hepatic adenoma, discussing your specific situation and treatment options with your healthcare provider is essential to ensure the best possible outcome.