Has your doctor told you that you are diagnosed with hepatic adenoma? No worries! That means that you have a liver tumour that is benign (non-cancerous).
Hepatic adenoma, also known as HCA, is an uncommon but benign epithelial tumour of the liver that is usually linked to contraceptive pill use. Therefore, it is associated with AFABs (assigned female at birth) in their reproductive age who take exogenous oestrogen in the form of contraceptive pills. It does not only affect AFABs; patients who are treated with anabolic steroids that mimic the effect of testosterone (and are used for athletic enhancement) are also affected. It is benign. However, it can create major health complications like haemorrhage and can also become cancerous.1 This article will provide more information on hepatic adenoma types, causes, signs and symptoms, management and treatment, diagnosis, risk factors, and complications.
Types of hepatic adenoma
The discovery of the role of beta-catenin from the Wnt signalling pathway in the development of hepatic adenomas in 2002 deepened our understanding of the molecular characteristics of hepatic adenomas. Professor Bioulac-Sage and associates developed a classification system for hepatic adenomas based on molecular characteristics called phenotypic-genotypic classification in 2007. This classification scheme has since been confirmed by other groups.2
The different molecular subtypes are:
- HNF1A-inactivated HCA, which represents 35% to 40% of all hepatic adenomas. Mostly seen in AFABs, HNF-1 inactivated adenomas usually don't have complications
- Inflammatory HCA accounts for 40% to 50% of the cases and is usually found in AFABs
- Beta-catenin activated usually represents 15% to 20% of the cases, and it is more common in those assigned male at birth (AMABs)
- Unclassified HCA represents 10% of hepatic adenomas1
Causes of hepatic adenoma
Do you know that anyone can get hepatic adenoma?
The major causes of liver cell tumours involve hormone changes. The risk of hepatic adenoma is increased by the intake of oestrogen-based birth control
Type 1 diabetes, high iron, obesity, barbiturate/steroid use, and pregnancy are other risk factors
Signs and symptoms of hepatic adenoma
Most people with liver adenoma have no symptoms until the tumour grows. As they grow, they may experience mild symptoms such as:
- Abdominal pain
In rare cases, the tumour might rupture and lead to severe bleeding, leading to symptoms like:
- Blood in your poo and vomit
- Severe abdominal pain
Diagnosis of hepatic adenoma
Dynamic magnetic resonance imaging (MRI) with a hepatocyte-specific contrast (a dye that is specific to the liver) agent is the best way to diagnose liver adenomas. This method allows the best differentiation between liver adenomas and other benign and malignant liver tumours.1
There should be important considerations during diagnosis like distinguishing between hepatocellular adenoma (HCA) (liver adenoma) and high-grade hepatocellular carcinoma (HCC) can be difficult, if not impossible, and should always be considered.
In some cases, your healthcare provider might request a liver biopsy to diagnose hepatocellular adenoma.
Management and treatment for hepatic adenoma
For small tumours that are less than 5 cm and linked to birth control pills, doctors usually start with simple treatment. The management of this problem involves stopping birth control pills and regularly checking the area with imaging tests. Stopping birth control pills has proven to make the tumours shrink almost completely in most cases. If you start taking birth control pills again, experts suggest getting medical imaging tests regularly up until menopause.
Obesity often makes it hard to treat certain types of tumours.
All AMAB patients should have surgery to remove the tumour. AFABs with tumours bigger than 5 cm should also have surgery to remove the tumour. Surgery can remove a part affected by the disease without taking out too much. It also does not require the removal of nearby lymph nodes. When surgery is chosen, it usually results in less than a 1% chance of death. If someone has a busted lump in their liver that causes bleeding inside their body, they might need surgery right away. This kind of surgery could lead to 5% to 10% of people not surviving.
Doctors suggest using transarterial embolization (TAE) for hepatic adenomas that lead to bleeding. People who bleed inside a tumour usually do not have serious problems with their blood pressure. This means doctors can use a procedure called TAE, followed by a planned surgery to remove the tumour. TAE is done 2 to 3 days after bleeding from a tumour.1
Treatment for liver adenomas is not always necessary unless there is a risk of rupture. AFABs with this condition may be advised to stop taking oral contraceptives and may monitor tumour growth. However, if the tumour is more than 2 inches in diameter or the patient is an AMAB, surgical removal may be recommended to prevent the risk of rupture or other complications.
It is not known why liver adenomas develop, but risk factors include obesity, fatty liver disease, and the use of oral contraceptives or anabolic steroids. Liver adenomas are more common in AFABs but occasionally occur in AMABs.
The possible complications of hepatic adenoma are transformation into cancerous tumours, spontaneous rupture, and bleeding. Surgical removal may be recommended to prevent further complications. Spontaneous rupture and hemo-peritonitis occur especially during menstruation, pregnancy, and after childbirth. Patients with large adenomas are also at increased risk of rupture.
How can I prevent hepatic adenoma?
Usually, HCAs are treated conservatively, and patients are advised to avoid oral contraceptives.
How common is hepatic adenoma?
Hepatic adenoma liver lesions are rare, and, when they occur, they are seen more commonly in AFABs of reproductive potential, especially those aged 20 to 44 years. The incidence is estimated at 3-4 per 100,000 AFABs.
When should I see a doctor?
If you are of childbearing age, you should be warned of developing lesions. Please do regular health check-ups.
Hepatic adenoma is a rare condition that mostly targets AFABs of reproductive age who are taking oral contraceptives. However, it also affects AMABs, especially people who take anabolic steroids. There are four types of hepatic adenoma, which are categorised based on their molecular characteristics, and they are different in prevalence percentage. Hepatic adenoma is caused by hormonal changes, and several other factors increase the probability of getting diagnosed with hepatic adenoma, like obesity, diabetes, and pregnancy. Most cases are asymptomatic until the tumour grows. The best way to diagnose it is through MRI and biopsies. Treatment involves stopping birth control pills, transarterial embolization (TAE) for hepatic adenomas that lead to bleeding followed by surgery, and removal of the tumour by surgery is done in cases where the tumour size is over 5 cm or when there is a busted lump. One of the complications of this disease is the cancerous transformation of the tumour. We encourage you to seek medical advice in case you are at risk of developing this condition.
- Shreenath AP, Kahloon A. Hepatic adenoma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 May 12]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK513264/
- Védie AL, Sutter O, Ziol M, Nault JC. Molecular classification of hepatocellular adenomas: impact on clinical practice. Hepat Oncol [Internet]. 2018 Apr 9 [cited 2023 May 12];5(1):HEP04. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6168043/