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 to appear in women between the ages of 20 and 50 after a pregnancy or due to the prolonged use of oral contraceptives, for example.
Normally, liver adenoma produces no symptoms, so it is 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, the adenoma generally 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.
In most cases, hepatic adenoma does not cause any symptoms, however, some people may report the presence of mild and constant pain in the upper right abdomen.
Although rare, the adenoma can rupture and bleed into the abdominal cavity. In such cases, it is common to experience very strong and sudden abdominal pain, which does not improve and which is accompanied by other symptoms of hemorrhagic shock such as increased heart rate, feeling faint or excessive sweating. If there is a suspicion that the adenoma has ruptured, it is advisable to go immediately to the hospital to stop the bleeding.
How the diagnosis is made
Hepatocellular adenoma is almost always identified during an exam to diagnose another problem, so if this happens, it is recommended to consult a hepatologist to do a more specific exam and confirm the presence of the adenoma. The most used exams include ultrasound, magnetic resonance or computed tomography.
During these exams, the doctor is also able to identify the type of liver adenoma to better guide treatment:
- Inflammatory : it is the most common and has a higher rupture rate;
- HNF1α mutation : it is the second most frequent type, and more than one adenoma can appear in the liver;
- Ss-catenin mutation : they are uncommon and appear mainly in men who use anabolic steroids;
- Not classifiable : it is a type of tumor that cannot be included in any other type.
Usually the doctor only recommends monitoring the size of the tumor, however, in the case of the inflammatory, for example, if it is more than 5 cm, the doctor may choose to have surgery to remove it completely.
How the treatment is done
Since liver adenoma is almost always benign, the main form of treatment is to constantly monitor its size, using tests such as computed tomography, magnetic resonance imaging or just ultrasound. However, if the adenoma arises in a woman who is using contraceptives, the doctor may advise to discontinue its use and choose another contraceptive method, since the use of the pill may be contributing to the development of the tumor. The same is true in people who are using some type of anabolic, for example.
If the tumor grows over time or if it is more than 5 cm, there is a greater risk of being able to rupture or develop cancer and, therefore, it is common for the doctor to recommend surgery to remove the lesion and prevent it from arising. complications. This surgery is usually quite simple and has little risk, being performed 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 major blood loss, which can be life-threatening.
There are two main complications of hepatic adenoma:
- Disruption : happens when the tumor walls rupture due to excessive size or direct trauma to the liver, for example. When this happens, the tumor is bleeding into the abdominal cavity, which leads to internal bleeding, putting life at risk. In these cases, it is common to feel 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, being able to undergo a transformation to 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, so it is very important to keep a regular watch at the hepatologist. .