Hepatobiliary and Pancreatic Surgery, Department of Surgical Oncology, Indraprastha Apollo Hospitals, New Delhi, India.
Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Clin Gastroenterol Hepatol. 2015 Jul;13(7):1221-30. doi: 10.1016/j.cgh.2014.05.023. Epub 2014 Jun 5.
Hepatocellular adenoma (HCA) is a rare benign liver cell neoplasm that occurs more frequently in young women with a history of prolonged use of oral contraceptives. Surgical resection is considered because of the risk of hemorrhage in 25% and of malignant transformation in 5% of patients with HCA. HCA is a heterogeneous disease comprising 3 subtypes with distinct molecular and complication profiles. The inflammatory or telangiectatic subtype is at increased risk for hemorrhage, the β-catenin-activated subtype is at increased risk for malignant transformation, and the hepatocyte nuclear factor-1α-inactivated or steatotic subtype is at the least risk for complications. One-third of the patients with HCA have multiple tumors on imaging with no increased risk of complications. Magnetic resonance imaging is the modality of choice for the diagnosis and subtype characterization of HCA. Systematic resection of HCA is recommended in male patients owing to the higher incidence of malignant transformation, and surgical excision in women should be reserved for tumors 5 cm or larger associated with an increased risk of complications. Cessation of hormonal therapy and radiologic surveillance in women with HCA tumors smaller than 5 cm shows that the vast majority of HCA remain stable or undergo spontaneous regression. Percutaneous core needle biopsy is of limited value because the therapeutic strategy is based primarily on patient sex and tumor size. Transarterial embolization is the initial treatment for HCA complicated by hemorrhage. Pregnancy should not be discouraged in the presence of HCA, however, frequent sonographic surveillance is recommended.
肝细胞腺瘤（HCA）是一种罕见的良性肝细胞瘤，在长期使用口服避孕药的年轻女性中更为常见。由于 25%的患者有出血风险，5%的患者有恶性转化风险，因此需要进行手术切除。HCA 是一种异质性疾病，由 3 种具有不同分子和并发症特征的亚型组成。炎症或毛细血管扩张型亚型出血风险增加，β-连环蛋白激活型亚型恶性转化风险增加，而肝细胞核因子-1α失活或脂肪变性型亚型并发症风险最小。三分之一的 HCA 患者在影像学上有多个肿瘤，但并发症风险没有增加。磁共振成像（MRI）是诊断和 HCA 亚型特征的首选方法。由于恶性转化发生率较高，建议对男性患者进行系统性切除，而对于女性患者，应保留手术切除，以治疗直径大于 5cm 且并发症风险增加的肿瘤。对于直径小于 5cm 的 HCA 肿瘤，停止激素治疗和影像学监测显示，绝大多数 HCA 保持稳定或自发消退。经皮核心针活检的价值有限，因为治疗策略主要基于患者性别和肿瘤大小。对于出血并发症的 HCA，最初的治疗方法是经动脉栓塞。有 HCA 的情况下不应劝阻妊娠，但建议进行频繁的超声监测。
