Question: A young female on oral contraceptives asks you what to do about her 4 hepatic adenomas; they range from 0.9 to 3.0 cm. She is asymptomatic.
A. stop the oral contraceptives; you are worried about malignant transformation into adenocarcinoma
B. stop the oral contraceptives; you are worried about malignant transformation into hepatocellular carcinoma
C. continue oral contraceptives but refer to a surgeon if any adenoma grows beyond 5 cm
D. hepatic adenomas are benign lesions; no precautions are necessary
Answer: Hepatic adenoma is common in young females, and unlike focal nodular hyperplasia (FNH) adenomas have a causal relationship with oral contraceptive use. In nearly any case, discontinuation of the oral contraceptive is indicated.
Why? There’s always the fear of growth and rupture, or malignant transformation. Remember that under a microscope, hepatic adenoma looks like sheets and sheets of regular hepatocytes (not even any bile ducts). The hepatocellular origin, therefore, suggests that the malignant transformation will be into a hepatocellular carcinoma.
We are learning a great deal about the genomic variants of hepatic adenoma, and perhaps one day we’ll more completely understand which signatures are associated with a particular biologic behavior. For more on this, refer to the following editorial in the July 2011 Journal of Hepatology: Classification of hepatocellular adenomas .