Hepatic adenoma: evolution of a more individualized treatment approach

• Published in: Journal of gastrointestinal surgery 2024-06, Vol.28 (6), p.975-982
• Main Authors: Aziz, Hassan, Underwood, Patrick W., Gosse, Matthew D., Afyouni, Shadi, Kamel, Ihab, Pawlik, Timothy M.
• Format: Article
• Language: English
• Subjects: Hepatocellular adenoma; Inflammatory hepatocellular adenoma; Malignancy; Sonic hedgehog hepatocellular adenoma; Unclassified hepatocellular adenoma
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1016/j.gassur.2024.03.010

Hepatic adenomas (HAs) are benign, solid liver lesions, which carry a risk of hemorrhage and malignant transformation. This review article highlights the advances in the diagnosis and management of HAs. A comprehensive review was performed using MEDLINE/PubMed and Web of Science databases with a search period ending on September 30, 2023. Using PubMed, the terms “hepatocellular,” “hepatic,” and “adenoma” were searched. HA has been classified into at least 8 subtypes based on molecular pathology, each exhibiting unique histopathologic features, clinical considerations, and risk of malignant transformation. The most common subtype is inflammatory HA, followed by hepatocyte nuclear factor 1α–inactivated HA, β-catenin exon 3-mutated HA (βex3-HA), β-catenin exon 7- or 8-mutated HA, sonic hedgehog HA, and unclassified HA. Magnetic resonance imaging is the best imaging method for diagnosis and can distinguish among HA subtypes based on fat and telangiectasia pathologic characteristics. The risk of malignant transformation varies among molecular subtypes, ranging from