Clinical Review of Hepatic Adenoma reported in Korea

Choi, Nam Soo; Kim, Byung Ho; Lee, Sung Bae; Jung, Il Woo; Dong, Seok Ho; Kim, Hyo Jong; Jang, Young Woon; Lee, Joung Il; Chang, Rin; Hong, Sung Hwa

Abstract

OBJECTIVES
Hepatic adenoma is a rare benign tumor, occuring in women of child-bearing age and it is known that hepatic adenoma is associated with history of oral contraceptive use in about 90% of cases, rarely with type I glycogen storage disease or anabolic steroids. There have been five cases of hepatic adenoma reported in Korea and three cases have been confirmed in our hospital. We examined the clinical findings of these eight cases and compare them with those of hepatic adenoma reported in western countries.
METHODS
We reviewed five cases published in medical literature of Korea and three cases confirmed in our hospital. The clinical, laboratory, and radiological features of the eight cases were examined and all were pathologically proven cases as hepatic adenoma.
RESULTS
Six cases were male and two cases were female. Mean age of them were 37+/-6 years old which ranged from 24 to 45 years old. Two cases of female did not have history of ingestion of oral contraceptives and six cases of male did not have history of having anabolic steroids. The associated diseases were chronic hepatitis B in two cases, glycogen storage disease type I in one case, and ovarian mucinous cystadenoma in one case. The presenting symptoms were upper abdominal discomfort in five cases, chronic fatigue in one case and two cases had no symptom. Hepatic adenomas were single mass in seven cases and only one case suspected of having glycogen storage disease showed six nodules. The mean diameter of the eight hepatic adenoma was 7.7+/-3.7cm which range from 2.0cm to 15cm. Seven of the eight cases were larger than 5cm in diameter. but there was no case of intraperitoneal bleeding. In laboratory studies, AST/ALT was elevated(81/84IU/L, normal range less than 40IU/L) in one case which was suspected of glycogen storage disease. Alkaline phosphatase were elevated in four cases and elevated alpha-FP was not found in any case. Hepatic adenoma was shown as hyperechoic mass with indistinct margin by ultrasonography and hypodense mass with contrast enhancement by computed tomography. Hepatic adenoma showed isodense or low signal intensity in T1WI, and low or high signal intensity in T2WI. Hepatic angiography showed hypervascular mass in six cases but avascular mass in two cases.
CONCLUSION
The reported cases of hepatic adenoma were predominant in men, associated with chronic hepatitis B in two cases, and females with hepatic adenoma had no history of having oral contraceptive. Despite the large size of hepatic adenoma, there was no case accompanied by peritoneal bleeding. These findings contrasts with those of hepatic adenoma reported in western countries. Therefore the pathogenesis and clinical course of hepatic adenoma in Korea may be different with those of hepatic adenoma occurring in western countries and further studies are needed.