hepatoma

Etiology

• risk factors:
  • oral contraceptives

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

Laboratory

• normal liver function tests

Diagnostic procedures

• hepatomas tend to bleed during liver biopsy or fine-needle aspiration, thus not recommended

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 (also see hepatocellular carcinoma)

Complications

• malignant transformation, hepatocellular carcinoma
• rupture with hemorrhage especially during pregnancy

Differential diagnosis

• focal nodular hyperplasia
  • not associated with oral contraceptives
  • generally < 3 cm
• hepatic abscess
• hepatocellular carcinoma
  • generally develops in patients with chronic liver disease, cirrhosis

Management

• 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
• women should discontinue oral contraceptives
• low risk hepatomas may be followed by CT surveillance every 6-12 months

More general terms

• liver neoplasm
• adenoma

Additional terms

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