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hepatoma

Etiology: - risk factors: - oral contraceptives [3] Pathology: - benign tumors at risk of malignant transformation - hormone-responsive neoplasm - generally found in the right lobe of the liver - immunohistochemistry for glutamine synthetase Genetics: - associated with defects in HNF1A (low risk hepatomas) - bi-allelic inactivation of HNF1A, sporadic or associated with MODY3, may be an early step in development of some hepatocellular carcinomas - beta-catenin gene mutation (activating mutation) - increased risk of hepatocellular carcinoma - hepatomas in men commonly have activating beta-catenin gene mutation - other implicated genes: VPS37A Clinical manifestations: - may be asymptomatic - abdominal pain or discomfort [3] Laboratory: - normal liver function tests Special laboratory: - hepatomas tend to bleed during liver biopsy or fine-needle aspiration, thus not recommended [3] Radiology: - contrast-enhanced CT - well defined mass may be > 5 cm - arterial enhancement - absence of a central scar - surveillance every 6-12 months for low risk hepatomas [1] (also see hepatocellular carcinoma) Complications: 1) malignant transformation, hepatocellular carcinoma 2) rupture with hemorrhage especially during pregnancy Differential diagnosis: 1) focal nodular hyperplasia - not associated with oral contraceptives - generally < 3 cm 2) hepatic abscess 3) hepatocellular carcinoma - generally develops in patients with chronic liver disease, cirrhosis [3] Management: 1) surgical resection - resection of larger hepatomas (> 5 cm) - resection of hepatomas in males - resection of hepatomas with beta-catenin activating mutation or positive glutamine synthetase immunohistochemistry 2) women should discontinue oral contraceptives 3) low risk hepatomas may be followed by CT surveillance every 6-12 months [1]

Related

focal nodular hyperplasia (liver) hepatic abscess hepatic cyst hepatocellular carcinoma

General

adenoma liver neoplasm

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018, 2021.
  2. Nault JC, Bioulac-Sage P, Zucman-Rossi J. Hepatocellular benign tumors-from molecular classification to personalized clinical care. Gastroenterology. 2013 May;144(5):888-902. Review. PMID: 23485860
  3. NEJM Knowledge+ Gastroenterology