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General Practice 2023

Hep´tic adenoma: what é, diagnosisóstic and treatment

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Hep´tic adenoma: what é, diagnosisóstic and treatment
Hep´tic adenoma: what é, diagnosisóstic and treatment

Hepatic adenoma, also known as hepatocellular adenoma, is a rare type of benign tumor of the liver that is produced by altered levels of hormones and is therefore more common in women between 20 and 50 years, after pregnancy or due to prolonged use of oral contraceptives, for example.

Normally, hepatic adenoma does not produce symptoms and is therefore almost always identified accidentally during a CT scan or ultrasound to try to diagnose another problem.

As it is not serious and is considered a benign tumor, adenoma usually does not need any specific type of treatment, it is only recommended to keep vigilance with regular exams, since, although it is very low, there is a risk of becoming malignant or rupture, causing internal bleeding.

Main symptoms

In most cases, hepatic adenoma does not cause any type of symptom, however, some people may report the presence of a mild and constant pain in the upper right region of the abdomen.

Although rare, the adenoma can rupture and bleed into the abdominal cavity. In these cases, it is common to experience a very strong and sudden abdominal pain, which does not improve and is accompanied by other symptoms of hemorrhagic shock such as increased heart rate, feeling faint or excessive sweating. If the adenoma is suspected to have ruptured, it is advisable to go to the hospital immediately to stop the bleeding.

Know other signs that may indicate hemorrhagic shock.

How the diagnosis is made

Hepatocellular adenoma is almost always identified during an exam to diagnose another problem and, therefore, if this happens, it is recommended to consult a hepatologist to perform a more specific exam and confirm the presence of the adenoma.The most used tests include ultrasound, magnetic resonance imaging or computed tomography.

During these exams, the doctor can also identify the type of hepatic adenoma to better guide the treatment:

  • Inflammatory: is the most common and has a higher breakout rate;
  • HNF1α mutation: it is the second most frequent type, and more than one adenoma may appear in the liver;
  • ß-catenin mutation: they are uncommon and appear mainly in men who use anabolic steroids;
  • Unclassifiablel: It is a type of tumor that cannot be included in any other type.

Usually the doctor recommends only monitoring the size of the tumor, however, in the case of inflammatory, for example, if it is larger than 5 cm, the doctor may choose to have surgery to remove it completely.

How the treatment is done

Since hepatic adenoma is almost always benign, the main form of treatment is to constantly monitor its size, through tests such as computed tomography, magnetic resonance imaging or just ultrasound. However, if the adenoma appears in a woman who is using contraceptives, the doctor may advise discontinuing its use and opting for another contraceptive method, since the use of the pill may be contributing to the development of the tumor. The same happens in people who are using some type of anabolic, for example.

If the tumor grows over time or is larger than 5 cm, there is a greater risk that it could rupture or develop cancer, so it is common for the doctor to recommend surgery to remove the lesion and prevent complications from arising. This surgery is usually quite simple and has little risk, being done under general anesthesia in the hospital.Surgery may also be advised for women who are considering becoming pregnant, as there is a greater risk of the adenoma causing complications during pregnancy.

If the adenoma has ruptured, the treatment used is also surgery, to stop the bleeding and remove the lesion. In these cases, treatment should be started as soon as possible to avoid massive, life-threatening blood loss.

Possible complications

There are two main complications of hepatic adenoma:

  • Rupture: happens when the walls of the tumor rupture due to excessive increase in size or direct trauma to the liver, for example. When this happens, the tumor bleeds into the abdominal cavity, which leads to internal bleeding and is ultimately life-threatening. In these cases, it is common to feel a very intense and sudden pain in the abdomen. If this happens, it is very important to go to the hospital immediately to start treatment.
  • Development of cancer: it is the rarest complication, but it can happen when the tumor continues to grow, and it can undergo a transformation into a malignant tumor, known as hepatocellular carcinoma. In these cases, it is important to make an early diagnosis to increase the chances of cure. Learn more about this type of tumor and how it is treated.

These complications are more common in tumors larger than 5 cm and, therefore, treatment is almost always done with surgery to remove the lesion, however, they can also happen in smaller tumors, which is why it is very important to maintain regular surveillance at the hepatologist.

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