WordNet

pertaining to or affecting the liver; "hepatic ducts"; "hepatic cirrhosis"
a benign epithelial tumor of glandular origin

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肝臓の;肝臓にきく,肝臓のような色の

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/04/07 23:03:48」(JST)

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Hepatocellular adenoma, also hepatic adenoma, or rarely hepadenoma, is an uncommon benign liver tumor which is associated with the use of hormonal contraception with a high estrogen content.^[1] Patients taking higher potency hormones, patients of advanced age, or patients with prolonged duration of use have a significantly increased risk of developing hepatocellular adenomas.^[2]

Signs and Symptoms

About 25-50% of hepatic adenomas cause pain in the right upper quadrant or epigastric region of the abdomen.^[2] Since hepatic adenomas can be large (8–15 cm), patients may notice a palpable mass. However, hepatic adenomas are usually asymptomatic, and may be discovered incidentally on imaging ordered for some unrelated reason.^[2] If not treated, there is a 30% risk of bleeding.^[3] Bleeding may lead to hypotension, tachycardia, and sweating (diaphoresis).

Diagnosis

It is important to distinguish hepatic adenoma from other benign liver tumors, such as hemangiomas and focal nodular hyperplasia, because hepatic adenomas have a small but meaningful risk of progressing into a malignancy.^[3] MRI is the most useful investigation in the diagnosis and work-up.^[4] A poly-phasic CT scan is another useful test for diagnosing hepatic adenoma.^[3]

Large hepatic adenomas have a tendency to rupture and bleed massively inside the abdomen.

Radiologic differential diagnosis

Echinococcal cyst
Focal fatty change
Focal nodular hyperplasia
Hepatoblastoma
Infiltrative liver disease
Inflammatory pseudotumor
Leiomyosarcoma
Lymphoma
Nodular regenerative hyperplasia

Pathologic diagnosis

Micrograph of a hepatic adenoma demonstrating a regular reticulin scaffold. Reticulin stain.

Hepatic adenomas are, typically, well-circumscribed nodules that consist of sheets of hepatocytes with a bubbly vacuolated cytoplasm. The hepatocytes are on a regular reticulin scaffold and less or equal to three cell thick.

The histologic diagnosis of hepatic adenomas can be aided by reticulin staining. In hepatic adenomas, the reticulin scaffold is preserved and hepatocytes do not form layers of four or more hepatocytes, as is seen in hepatocellular carcinoma.

Cells resemble normal hepatocytes and are traversed by blood vessels but lack portal tracts or central veins.

Etiology

Ninety percent of hepatic adenomas arise in women aged 20–40, most of whom use oral contraceptives.

Related Conditions

Hepatic adenomas are related to glycogen storage diseases, type 1, as well as anabolic steroid use.

Treatment

Some authors feel that all hepatocellular adenoma should be resected, because of the risk of rupture causing bleeding and because they may contain malignant foci.^[5] Current recommendations are that all hepatic adenomas should be resected, as long as they are surgically accessible and the patient is a reasonable operative candidate.^[6] Patients with adenomas should avoid oral contraceptives or hormonal replacement therapy.

Pregnancy could cause the adenoma to grow faster, so patients with hepatic adenomas should avoid pregnancy.^[7]

Additional images

Micrograph of hepatic adenoma. H&E stain.
Micrograph of hepatic adenoma. Reticulin stain.

References

^ Rooks J, Ory H, Ishak K, Strauss L, Greenspan J, Hill A, Tyler C (1979). "Epidemiology of hepatocellular adenoma. The role of oral contraceptive use.". JAMA 242 (7): 644–8. doi:10.1001/jama.242.7.644. PMID 221698.
^ ^a ^b ^c "Hepatocellular Adenoma: eMedicine Gastroenterology".
^ ^a ^b ^c Anthony S. Fauci , Eugene Braunwald, Dennis L. Kasper, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, Joseph Loscalzo (2008). Harrison's principles of internal medicine (17th ed. ed.). New York: McGraw-Hill Medical. pp. Chapter 92 (benign liver tumors). ISBN 978-0071466332.
^ Hussain S, van den Bos I, Dwarkasing R, Kuiper J, den Hollander J (2006). "Hepatocellular adenoma: findings at state-of-the-art magnetic resonance imaging, ultrasound, computed tomography and pathologic analysis.". Eur Radiol 16 (9): 1873–86. doi:10.1007/s00330-006-0292-4. PMID 16708218.
^ Toso C, Majno P, Andres A, Rubbia-Brandt L, Berney T, Buhler L, Morel P, Mentha G (2005). "Management of hepatocellular adenoma: solitary-uncomplicated, multiple and ruptured tumors.". World J Gastroenterol 11 (36): 5691–5. PMID 16237767. Full text
^ Cho, S; Marsh J; Steel J et al. (2008). "Surgical management of hepatocellular adenoma: take it or leave it?". Ann Surg Oncol (15): 2795–2803.
^ "Hepatocellular Adenoma Treatment & Management". WebMD. Medscape. Retrieved 11 July 2012.

External links

University of Utah - Pathology Images

UpToDate Contents

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1. 肝腺腫 hepatic adenoma
2. 固形肝病変：鑑別診断および評価 solid liver lesions differential diagnosis and evaluation
3. 限局性結節性過形成 focal nodular hyperplasia
4. 既存の慢性肝疾患を有する女性における妊娠 pregnancy in women with pre existing chronic liver disease
5. エストロゲン・プロゲスチン避妊剤と関連したリスクおよび副作用 risks and side effects associated with estrogen progestin contraceptives

English Journal

The impact of obesity on liver histology.

Goodman ZD.Author information Center for Liver Diseases, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA. Electronic address: zachary.goodman@inova.org.AbstractObesity and insulin resistance produce alterations in the liver's normal role in lipid metabolism resulting in a sequence of changes recognizable on liver biopsy. Hepatocellular fat vacuoles increase with BMI, producing steatosis. Steatohepatitis occurs when there is also cytoskeletal damage with loss of keratin filaments, ballooning of affected liver cells and formation of Mallory-Denk bodies. Activation of hepatic stellate cells produces fibrosis in the perisinusoidal spaces. With continuing fibrogenesis there is progression to bridging fibrosis and cirrhosis. Hepatocellular carcinoma may develop in the cirrhotic liver, but both hepatocellular adenoma and hepatocellular carcinoma may occur in pre-cirrhotic fatty liver disease.
Clinics in liver disease.Clin Liver Dis.2014 Feb;18(1):33-40. doi: 10.1016/j.cld.2013.09.010. Epub 2013 Oct 25.
Obesity and insulin resistance produce alterations in the liver's normal role in lipid metabolism resulting in a sequence of changes recognizable on liver biopsy. Hepatocellular fat vacuoles increase with BMI, producing steatosis. Steatohepatitis occurs when there is also cytoskeletal damage with lo
PMID 24274863

Case study on the utility of hepatic global gene expression profiling in the risk assessment of the carcinogen furan.

Jackson AF1, Williams A2, Recio L3, Waters MD4, Lambert IB5, Yauk CL6.Author information 1Environmental Health Science and Research Bureau, Health Canada, Ottawa K1A 0K9, Canada; Department of Biology, Carleton University, 1125 Colonel By Drive, Ottawa K1S 5B6, Canada. Electronic address: Francina.Jackson@hc-sc.gc.ca.2Environmental Health Science and Research Bureau, Health Canada, Ottawa K1A 0K9, Canada. Electronic address: Andrew.Williams@hc-sc.gc.ca.3ILS, Inc., P.O. Box 13501, Research Triangle Park, NC 27709, USA. Electronic address: lrecio@ils-inc.com.4ILS, Inc., P.O. Box 13501, Research Triangle Park, NC 27709, USA. Electronic address: mwaters@ils-inc.com.5Department of Biology, Carleton University, 1125 Colonel By Drive, Ottawa K1S 5B6, Canada. Electronic address: Iain.Lambert@carleton.ca.6Environmental Health Science and Research Bureau, Health Canada, Ottawa K1A 0K9, Canada. Electronic address: Carole.Yauk@hc-sc.gc.ca.AbstractFuran is a chemical hepatocarcinogen in mice and rats. Its previously postulated cancer mode of action (MOA) is chronic cytotoxicity followed by sustained regenerative proliferation; however, its molecular basis is unknown. To this end, we conducted toxicogenomic analysis of B3C6F1 mouse livers following three week exposures to non-carcinogenic (0, 1, 2mg/kgbw) or carcinogenic (4 and 8mg/kgbw) doses of furan. We saw enrichment for pathways responsible for cytotoxicity: stress-activated protein kinase (SAPK) and death receptor (DR5 and TNF-alpha) signaling, and proliferation: extracellular signal-regulated kinases (ERKs) and TNF-alpha. We also noted the involvement of NF-kappaB and c-Jun in response to furan, which are genes that are known to be required for liver regeneration. Furan metabolism by CYP2E1 produces cis-2-butene-1,4-dial (BDA), which is required for ensuing cytotoxicity and oxidative stress. NRF2 is a master regulator of gene expression during oxidative stress and we suggest that chronic NFR2 activity and chronic inflammation may represent critical transition events between the adaptive (regeneration) and adverse (cancer) outcomes. Another objective of this study was to demonstrate the applicability of toxicogenomics data in quantitative risk assessment. We modeled benchmark doses for our transcriptional data and previously published cancer data, and observed consistency between the two. Margin of exposure values for both transcriptional and cancer endpoints were also similar. In conclusion, using furan as a case study we have demonstrated the value of toxicogenomics data in elucidating dose-dependent MOA transitions and in quantitative risk assessment.
Toxicology and applied pharmacology.Toxicol Appl Pharmacol.2014 Jan 1;274(1):63-77. doi: 10.1016/j.taap.2013.10.019. Epub 2013 Oct 29.
Furan is a chemical hepatocarcinogen in mice and rats. Its previously postulated cancer mode of action (MOA) is chronic cytotoxicity followed by sustained regenerative proliferation; however, its molecular basis is unknown. To this end, we conducted toxicogenomic analysis of B3C6F1 mouse livers foll
PMID 24183702

Indeterminate solid hepatic lesions identified on non-diagnostic contrast-enhanced computed tomography: Assessment of the additional diagnostic value of contrast-enhanced ultrasound in the non-cirrhotic liver.

Quaia E1, De Paoli L2, Angileri R2, Cabibbo B2, Cova MA2.Author information 1Department of Radiology, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy. Electronic address: quaia@units.it.2Department of Radiology, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy.AbstractOBJECTIVE: To assess the additional diagnostic value of contrast-enhanced ultrasound (CEUS) in the characterization of indeterminate solid hepatic lesions identified on non-diagnostic contrast-enhanced computed tomography (CT).
European journal of radiology.Eur J Radiol.2013 Dec 16. pii: S0720-048X(13)00655-4. doi: 10.1016/j.ejrad.2013.12.012. [Epub ahead of print]
OBJECTIVE: To assess the additional diagnostic value of contrast-enhanced ultrasound (CEUS) in the characterization of indeterminate solid hepatic lesions identified on non-diagnostic contrast-enhanced computed tomography (CT).METHODS: Fifty-five solid hepatic lesions (1-4cm in diameter) in 46 non-c
PMID 24387826

Related Pictures

File:Hepatic adenoma high mag.jpg - Wikimedia Commons Hepatocellular Adenomas Hepatocellular adenoma - Wikipedia Adenoma, liver cell; Adenoma, Hepatocellular; Hepatoma, Benign

★リンクテーブル★

リンク元	「肝腫瘍」「肝細胞腺腫」「HA」
関連記事	「hepatic」「adeno」

「肝腫瘍」

Hepatocellular adenoma
	Micrograph of a hepatic adenoma (bottom of image). H&E stain.
Classification and external resources
ICD-O:	M8170/0
DiseasesDB	5726
eMedicine	med/48
MeSH	D018248

　　[★]

英: liver tumor, hepatic tumor, hepatic neoplasm, liver neoplasm, tumor of the liver
関: 肝癌、肝臓癌

分類

SRA.472

原発性

良性

悪性

肝細胞癌 hepatocellular carcinoma HCC　→　脂肪を含むことが多いらしい。
胆管細胞癌 cholangiocellular carcinoma CCC
肝嚢胞腺癌 cystadenocarcinoma
肝細胞癌と胆管細胞癌の混合型
胆管嚢腺腫
肝芽腫
未分化癌

非上皮性腫瘍

良性

血管腫(肝血管腫, 良性肝腫瘍のうち最多, 大型の肝血管腫によりカサバッハ・メリット症候群をきたしうる)
胆管過誤腫 bile duct hamartoma
血管筋脂肪腫 angiomyolipoma

悪性

血管肉腫
胎芽性肉腫

転移性

転移性肝癌

肝細胞癌の鑑別疾患となる良性腫瘍

SSUR.594

検査

超音波エコー：(肝細胞癌)線維性被膜を有する境界明瞭な腫瘤でモザイクパターンを呈する。(転移性肝癌)低エコーの結節病変の中心に高エコーを有するbull's eye signを認める。

参考

1. Fat-containing lesions of the liver: radiologic-pathologic correlation.

Prasad SR, Wang H, Rosas H, Menias CO, Narra VR, Middleton WD, Heiken JP.SourceDepartment of Radiology, University of Texas Health Science Center at San Antonio, USA.
Radiographics : a review publication of the Radiological Society of North America, Inc.Radiographics.2005 Mar-Apr;25(2):321-31.
Fat-containing tumors of the liver are a heterogeneous group of tumors with characteristic histologic features, variable biologic profiles, and variable imaging findings. Benign liver lesions that contain fat include focal or geographic fatty change (steatosis), pseudolesions due to postoperative pa
PMID 15798052

脂肪を含む肝腫瘍は画像検査で鑑別診断を狭めることが可能である。

「肝細胞腺腫」

　　[★]

英: hepatocellular adenoma HCA, liver cell adenoma LCA, hepatic adenoma HA
関: 肝腫瘍

疫学

女性に多い。男女比=1:9 (NSU.618)。好発年齢20-40 (NSU.618)。
経口避妊薬や蛋白同化ホルモンの長期服用の既往があることが多い

病理

線維性被膜を有し、灰黄色・褐色、孤立性が多い。(NSU.618)
肝細胞が索状または管腔状に配列し、中心静脈も門脈域も認めない。(NSU.618)　←　顕微鏡的には正常肝細胞に似た細胞からなる(APT.212)
腺腫は胆汁を産生するので、固定標本では緑色に見える(APT.212)

治療

NSU.618

経口避妊薬を服用している場合にはこれを中止。
腫瘍が小さく、増大傾向無ければ経過観察。
収容が増大し、腫瘍内での出血、壊死、腹腔内は列の可能性のある場合や、肝細胞との鑑別が困難な場合には切除。

「HA」

　　[★]

「hepatic」

　　[★]

adj.

肝臓の、肝性の、肝の

関: hepato、hepatogenic、liver

「adeno」

　　[★]

comb form.
アデノ、腺の

関: gland、glandular

[1] Rooks J, Ory H, Ishak K, Strauss L, Greenspan J, Hill A, Tyler C (1979). "Epidemiology of hepatocellular adenoma. The role of oral contraceptive use.". JAMA 242 (7): 644–8. doi:10.1001/jama.242.7.644. PMID 221698.

[urlHepatocellular_Adenoma:_eMedicine_Gastroenterology-2] "Hepatocellular Adenoma: eMedicine Gastroenterology".

[HarrisonsInternal-3] Anthony S. Fauci , Eugene Braunwald, Dennis L. Kasper, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, Joseph Loscalzo (2008). Harrison's principles of internal medicine (17th ed. ed.). New York: McGraw-Hill Medical. pp. Chapter 92 (benign liver tumors). ISBN 978-0071466332.

[4] Hussain S, van den Bos I, Dwarkasing R, Kuiper J, den Hollander J (2006). "Hepatocellular adenoma: findings at state-of-the-art magnetic resonance imaging, ultrasound, computed tomography and pathologic analysis.". Eur Radiol 16 (9): 1873–86. doi:10.1007/s00330-006-0292-4. PMID 16708218.

[5] Toso C, Majno P, Andres A, Rubbia-Brandt L, Berney T, Buhler L, Morel P, Mentha G (2005). "Management of hepatocellular adenoma: solitary-uncomplicated, multiple and ruptured tumors.". World J Gastroenterol 11 (36): 5691–5. PMID 16237767. Full text

[6] Cho, S; Marsh J; Steel J et al. (2008). "Surgical management of hepatocellular adenoma: take it or leave it?". Ann Surg Oncol (15): 2795–2803.

[7] "Hepatocellular Adenoma Treatment & Management". WebMD. Medscape. Retrieved 11 July 2012.

匿名

検索

案内

案内

hepatic adenoma