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a benign epithelial tumor of glandular origin

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/11/29 18:23:54」(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 adenoma 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". http://emedicine.medscape.com/article/170205-overview.
^ ^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. http://www.accessmedicine.com/content.aspx?aID=9116285.
^ 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. http://emedicine.medscape.com/article/170205-treatment. Retrieved 11 July 2012.

External links

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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. 肝臓病変の評価のための造影超音波検査 contrast enhanced ultrasound for the evaluation of liver lesions

English Journal

MRI for characterization of primary tumors in the non-cirrhotic liver: Added value of Gd-EOB-DTPA enhanced hepatospecific phase.

Donati OF1, Hunziker R1, Fischer MA1, Raptis DA2, Breitenstein S2, Patak MA3.
European journal of radiology.Eur J Radiol.2014 Jul;83(7):1074-9. doi: 10.1016/j.ejrad.2014.03.020. Epub 2014 Apr 12.
PURPOSE: To evaluate the added value of hepatospecific phase in Gd-EOB-DTPA enhanced magnetic resonance imaging (MRI) in patients with primary tumors in non-cirrhotic liver.METHODS: Twenty-nine patients (median, 39 years; range, 18-81 years; 11 male) underwent preoperative Gd-EOB-DTPA enhanced MRI i
PMID 24816085

Synthesis and evaluation of (18)F-labeled bile acid compound: A potential PET imaging agent for FXR-related diseases.

Jia L1, Jiang D1, Hu P2, Li X2, Shi H2, Cheng D3, Zhang L4.
Nuclear medicine and biology.Nucl Med Biol.2014 Jul;41(6):495-500. doi: 10.1016/j.nucmedbio.2014.03.016. Epub 2014 Apr 1.
The farnesoid-X-receptor (FXR) is a member of the nuclear hormone receptor superfamily. The FXR has critical functions in maintaining bile acid synthesis and homeostasis, liver regeneration and tumorigenesis, intestinal diseases, intestinal tumorigenesis, cholesterol gallstone disease, cholestasis,
PMID 24776092

A case of cholangiocellular carcinoma in a patient with glycogen storage disease type Ia.

Kanamori H1, Nakade Y, Yamamoto T, Kobayashi Y, Sato K, Ito K, Ohashi T, Nakao N, Ishii N, Takahashi E, Yokoi T, Nakao H, Kurokawa T, Yamaguchi C, Yoneda M.
Hepatology research : the official journal of the Japan Society of Hepatology.Hepatol Res.2014 Jun 6. doi: 10.1111/hepr.12366. [Epub ahead of print]
Glycogen storage disease (GSD) type Ia is caused by a deficiency in glucose-6-phosphatase. Long-term complications, including renal disease, gout, osteoporosis and pulmonary hypertension, are developed in patients with GSD type Ia. In the second or third decade, almost GSD type Ia patients develop h
PMID 24905794

Japanese Journal

肝血管筋脂肪腫との鑑別が困難であった高度脂肪化を伴う大型高分化型肝細胞癌の1例

小倉俊郎,伴大輔,工藤篤,小林大輔,有井滋樹
日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 72(7), 1821-1826, 2011-07-25
NAID 10029613483

肝細胞癌と画像上鑑別が困難であった甲状腺濾胞癌肝転移の1例

服部伸洋,長瀬良彦,黄世揚,山田典栄,岡本賢,小林稔,池田裕喜,福田安伸,高橋秀明,石井俊哉,松永光太郎,馬場哲,松本伸行,奥瀬千晃,小林慎二郎,小泉哲,朝倉武士,大坪毅人,土居正知,小池淳樹,相田芳夫,高木正之,鈴木通博
肝臓 52(7), 477-484, 2011-07-25
症例は63歳女性．2009年9月の健診でγ-GTPの軽度上昇認め，腹部超音波検査を施行し，肝右葉に腫瘤病変を指摘され当院紹介となった．血液生化学検査においてγ-GTP以外の肝胆道系酵素に上昇はなく，肝炎ウイルスマーカー，腫瘍マーカーを含め異常所見は認めなかった．US，CT，MRI画像所見では，肝右葉に80 mm大の内部壊死を伴う多血性腫瘍を認め，肝細胞癌（HCC）が疑われた．腰痛の訴えから施行した …
NAID 10029285882

Related Pictures

★リンクテーブル★

リンク元	「肝細胞腺腫」
関連記事	「hepatocellular」「adeno」

「肝細胞腺腫」

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

　　[★]

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。

「hepatocellular」

　　[★]

肝細胞性の、肝細胞の

関: hepatic cell、hepatic parenchymal cell、hepatocyte、hepatocytic、liver cell

「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". http://emedicine.medscape.com/article/170205-overview.

[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. http://www.accessmedicine.com/content.aspx?aID=9116285.

[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. http://emedicine.medscape.com/article/170205-treatment. Retrieved 11 July 2012.

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案内

案内

hepatocellular adenoma