A practical contribution to the diagnostics and treatment of focal nodular hyperplasia and adenomas in the liver from the perspective of a hepatologist, radiologist, pathologist and surgeon


Authors: H. Gottfriedová 1;  E. Honsová 2;  D. Cupalová 3;  M. Oliverius 4;  D. Kautznerová 3;  L. Morávková 1;  J. Špičák 1;  P. Trunečka 5
Authors‘ workplace: Klinika hepatogastroenterologie, IKEM, Praha 1;  Pracoviště klinické a transplantační patologie, IKEM, Praha 2;  Pracoviště radiodiagnostiky a intervenční radiologie, IKEM, Praha 3;  Klinika transplantační chirurgie, IKEM, Praha 4;  Transplantcentrum, IKEM, Praha 5
Published in: Gastroent Hepatol 2015; 69(1): 56-64
Category: Hepatology: Review article
doi: 10.14735/amgh201556

Overview

Focal nodular hyperplasia and adenomas are benign hepatocellular lesions. The risk of life‑ threatening bleed­ing and malignant transformation of adenomas require accurate diagnosis of both units and their differentiation not only from each other but also from other liver tumors. The progress in the area of imaging methods and particularly in the histopathological diagnosis leads to a more accurate differentiation using imaging methods, resection specimens and needle bio­psies. Magnetic resonance imaging with a contrast medium plays an important role in the diagnostics, in the differentiation of adenoma subtypes and in the detection of adenoma complications; it also allows to establish differential diag­nosis of focal nodular hyperplasia and adenoma. The use of genetic and immunohistochemical methods helps to distinguish adenoma subgroups with varying risk of hemorrhage and malignant transformation –  this enables the application of an individualized surgical treatment in high risk adenomas and conservative treatment of small tumors with low risk of malignant transformation. The diagnosis is a result of a comprehensive assessment of the clinical and laboratory image, imaging methods and morphological evaluation. The therapeutic approach is individualized and requires multidisciplinary cooperation of experienced professionals.

Key words:
focal nodular hyperplasia –  liver adenoma –  subtypes of adenomas –  diagnosis –  treatment

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
8. 12. 2014

Accepted:
3. 2. 2015


Sources

1. Wanless IR, Mawdsley C, Adams R. On the pathogenesis of focal nodular hyperplasia of the liver. Hepatology 1985; 5(6): 1194– 1200.

2. Braga L, Armao D, Elazzazi M et al. Liver. In: Semelka RC. Abdominal‑ pelvic MRI. New Jersey: John Willey & Sons 2010: 107– 121.

3. Demarco MP, Shen P, Bradley RF et al. Intraperitoneal hemorrhage in a patient with hepatic focal nodular hyperplasia. Am Surg 2006; 72(6): 555– 559.

4. Sadowski DC, Lee SS, Wanless IR et al. Progressive type of focal nodular hyperplasia characterized by multiple tumors and recurrence. Hepatology 1995; 21(4): 970– 975.

5. Mathieu D, Kobeiter H, Maison P et al. Oral contraceptive use and focal nodular hyperplasia of the liver. Gastroenterology 2000; 118(3): 560– 564.

6. Kim H, Jang JJ, Kim DS et al. Clinicopathological analysis of hepatocellular adenoma according to new bordeaux classification: report of eight korean cases.Korean J Pathol 2013; 47(5): 411– 417. doi: 10.4132/ KoreanJPathol.2013.47.5.411.

7. Baum JK, Bookstein JJ, Holtz F et al. Possible association between benign hepatomas and oral contraceptives. Lancet 1973; 2(7835): 926– 929.

8. Rooks JB, Ory HW, Ishak KG et al. Epidemiology of hepatocellular adenoma. The role of contraceptive use. JAMA 1979; 242(7): 644– 648.

9. Thomeer MG, Bröker ME,de Lussanet Q et al. Genotype‑ phenotype correlations in hepatocellular adenoma: an update of MRI findings. Diagn Interv Radiol 2014; 20(3): 193– 199. doi: 10.5152/ dir.2013.13315.

10. Bioulac‑ Sage P, Balabaud C, Zucman‑ Rossi J. Subtype classification of hepatocellular adenoma. Dig Surg 2010; 27(1): 39– 45. doi: 10.1159/ 000268406.

11. Honsová E, Lodererová A, Gottfriedová H.Jak v praxi zlepšit bio­ptickou diagnostiku benigních lézí jater (adenom versus fokální nodulární hyperplazie). Čes Slov Patol 2013; 49(4): 149– 152.

12. Evason KJ, Grenert JP, Ferrell LD et al. Atypical hepatocellular adenoma‑like neoplasms with β‑ catenin activation show cytogenetic alterations similar to well‑dif­ferentiated hepatocellular carcinomas. Hum Pathol 2013; 44(5): 750– 758. doi: 10.1016/ j.humpath.2012.07.019.

13. Cho SW, Marsh JW, Steel J et al. Surgical management of hepatocellular adenoma: take it or leave it? Ann Surg Oncol 2008; 15(10): 2795– 2803. doi: 10.1245/  s10434‑ 008‑ 0090‑ 0.

14. Dokmak S, Paradis V, Vilgrain V et al. A single‑center surgical experience of 122 patients with single and multiple hepatocellular adenomas. Gastroenterology 2009, 137(5): 1698– 1705. doi: 10.1053/ j.gastro.2009.07.061.

15. Cescon M, Vetrone G, Grazi GL et al. Trends in perioperative outcome after hepatic resection: analysis of 1500 consecutive unselected cases over 20 years. Ann Surg 2009; 249(6): 995– 1002. doi: 10.1097/ SLA.0b013e3181a63c74.

16. Erdogan D, van Delden OM, Busch OR et al. Selective transcatheter arterial embolization for treatment of bleed­ing complications or reduction of tumor mass of hepatocellular adenomas. Cardiovasc Intervent Radiol 2007; 30(6): 1252– 1258.

17. Flejou JF, Barge J, Menu Y et al. Liver adenomatosis. An entity distinct from liver adenoma? Gastroenterology 1985; 89(5): 1132– 1138.

18. Chiche L, Dao T,Salamé E et al. Liver adenomatosis: reappraisal, diagnosis, and surgical management: eight new cases and review of the literature. Ann Surg 2000; 231(1): 74– 81.

19. Veteläinen R, Erdogan D, de Graaf W et al.Liver adenomatosis: re‑evaluation of aetiology and management. Liver Int 2008; 28(4): 499– 508. doi: 10.1111/ j.1478– 3231.2008.01669.x.

20. Marino IR, Scantlebury VP, Bronsther O et al.Total hepatectomy and liver transplant for hepatocellular adenomatosis and focal nodular hyperplasia. Transpl Int 1992; 5 (Suppl 1): S201– S205.

21. Ercolani G, Grazi GL, Pinna AD. Liver transplantation for benign hepatic tumors: a systematic review. Dig Surg 2010; 27(1): 68– 75. doi: 10.1159/ 000268628.

22. Cobey FC, Salem RR. A review of liver masses in pregnancy and a proposed algorithm for their diagnosis and management. Am J Surg 2004; 187(2): 181– 191.

23. Noels JE, van Aalten SM, van der Windt DJ et al. Management of hepatocellular adenoma during pregnancy. J Hepatol 2011; 54(3): 553– 558. doi: 10.1016/ j.jhep.2010.07.022.

Labels
Paediatric gastroenterology Gastroenterology and hepatology Surgery

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