Liver Cell Adenoma - Causes, Types, and Treatment

Introduction:

Liver cell adenoma is also called hepatocellular adenoma. It is a rare type of lesion mostly seen in females who take oral contraceptive pills. It does not usually create any symptoms. If the tumor size is large beyond 5 cm, it can create symptoms like pain in the right upper region above the abdomen and a mass felt in the area above the stomach region. The diagnostic methods include ultrasound, CT scan, MRI scan, and biopsy. The hepatocellular adenoma is usually asymptomatic, and monitoring the size of the tumor is suggested in most cases. If the tumor size is large or causes symptoms, then surgical removal will be considered.

What Is Liver Cell Adenoma?

Hepatocellular adenoma or liver cell adenoma is a rare, solid, non-cancerous tumor seen in the pre-menopausal stage in females. It is associated with taking birth control pills. Liver cell adenoma is also seen in males who take anabolic steroids and people with genetic disorders like type I and III glycogen storage disease (a disease that involves the accumulation of a sugar called glycogen in body cells). The tumor consists mostly of fats and a type of sugar called glycogen.

What Are the Types of Liver Cell Adenoma?

• Inflammatory Hepatic Adenoma: This is the most common type and has the highest bleeding rate. They are usually found in women.

• Hnf-1 Alpha Mutated (Inactivated) Hepatic Adenoma: It is the second most common type of hepatic adenoma and is often multiple in numbers. This type is commonly seen in women, and they do not cause any complications.

• Beta-Catenin Activated: This is the least common type of liver cell adenoma. This type is seen in men who take anabolic steroids and people with anabolic storage disease.

• Unclassified Hepatic Adenoma: This is a rare type of adenoma and has an increased risk of malignant transformation.

What Causes Liver Cell Adenoma?

• Oral Contraceptive Pills: Women above 30 years of age who have been taking a heavy dose of estrogen-containing oral contraceptive pills for more than five years.

• Obesity: Overweight and excess fat deposition in the body.

• Inherited Glycogen Storage Disease Type I And III: A genetically acquired disease that results in excess storage of a type of sugar called glycogen in the body cells.

• Anabolic Steroids: A man-made steroid hormone similar to testosterone, which is used to build muscle mass.

• Pregnancy: During pregnancy, the body releases high amounts of sex hormones, and this causes liver cell adenoma.

• Diabetes Mellitus: It is a metabolic disease when there is an improper carbohydrate metabolism, and the body does not produce more insulin to maintain proper sugar balance in the blood.

• Barbiturates: It is a medication that is used for relaxation, to cause sleep, and as anticonvulsants (medication for seizures).

What Are the Symptoms of Liver Cell Adenoma?

Liver cell adenoma usually does not produce symptoms. If the size of the tumor is large or the tumor ruptures, a few symptoms may occur.

• Pain in the right upper region above the stomach.

• Stomach fullness or bloating.

• Vomiting.

• Cold sweats (sweating suddenly due to heat or cold).

• Internal bleeding (bleeding inside the abdomen).

• A fast pulse rate.

How Is Liver Cell Adenoma Found?

• Ultrasound Scan: A high-frequency sound wave is used to capture images of structures or organs inside the body. An ultrasound scan of the abdomen helps to find the liver disease.

• CT Scan: Computerized tomography (CT) is a series of X-ray images taken from different angles of the body. It provides a detailed image of the structures captured. CT scan helps find out liver disease.

• MRI Scan: Magnetic resonance imaging (MRI) uses a combination of a strong magnetic field and high-frequency radio waves to take a detailed picture of the internal structures in our body. This scan provides a more detailed image of the structure to find out the disease.

• Liver Biopsy: Liver biopsy involves the removal of a very small part of the liver tissue to view the changes at a microscopic level. The result of this test provides the details of the type of the disease. This is a confirmatory test.

Who Is at Risk for Liver Cell Adenoma?

• Women who take high-dose contraceptive pills for more than three years.

• People who take anabolic steroids.

• Obesity.

• Diabetes mellitus.

What Is the Treatment for Liver Cell Adenoma?

Liver cell adenoma rarely causes symptoms initially. In some cases, the lesion is diagnosed accidentally while screening for any other disease. Though the lesion is trouble-less, in some cases, when the size of the tumor is large, few treatment options might be suggested.

• Quit Birth Control Pills: The doctor will recommend stopping birth control pills for the tumor size to shrink. This will be monitored through imaging studies.

• MRI Scan Monitoring: If the tumor size is small, less than 5 cm, and does not produce any symptoms, monitoring the size of the tumor will be recommended. Monitoring the size of the tumor through an MRI scan for six months initially, followed by a period of one year, will be recommended.

• Surgery: Surgery will be recommended when the tumor size is more than 5 cm or if the tumor is symptomatic. Surgery is also recommended in men since the adenomas have an increased risk of malignant transformation in men. Surgery is also done when the tumor ruptures. The bleeding is controlled, and the tumor is removed.

• Transarterial embolization: In transarterial embolization, the blood supply to the tumor is blocked.

• Radiofrequency Ablation: Radiofrequency ablation uses an electric current to heat the nerve tissue to reduce and stop the pain. This procedure is used when the tumor size is less than 3 cm and causes pain.

Do Pregnant Women Get Hepatic Adenoma?

During pregnancy, there is an increase in the sex hormones in the circulation. This triggers the formation of hepatic adenoma in pregnant females. The treatment would be surgical removal, as pregnant females have a high risk of spontaneous rupture of the tumor. The surgery will be performed during the second trimester (four to six months).

What Are the Complications of Liver Cell Adenoma?

• Internal bleeding due to bursting of the tumor.

• Men with hepatic adenomas are at risk of transforming into malignant (spreading) tumors.

• Malignant transformation if the tumor size is large.

• Malignant transformation if the hepatic adenoma is a beta-catenin-activated tumor.

What Is the Prognosis of Liver Cell Adenoma?

The prognosis of hepatic cell adenoma is good if the tumor is detected and treated early.

Conclusion:

Hepatic cell adenoma or liver cell adenoma is a rare, solid, and benign (non-cancerous) tumor. These tumors in females are asymptomatic in most cases and do not require treatment. If the lesion size is big or if it causes painful symptoms, surgical removal will be the choice of treatment. In male patients, the treatment is surgical removal since they have a high risk of the tumor transforming into a malignant one. If the tumor is not treated after it causes symptoms, the chances of the tumor bursting and bleeding into the abdominal cavity are high, and the chances of becoming malignant are also high.

Early detection of the tumor and following appropriate treatment protocols and lifestyle modification can increase the lifespan of the patient with good outcomes.