Liver adenoma: symptoms, formation and treatment

A liver adenoma is a rare type of non-cancerous tumor that forms in the liver and usually occurs in young women with a history of taking oral contraceptives. People often become aware of this when they undergo imaging tests such as ultrasound, magnetic resonance imaging (MRI), or computed tomography (CT) for other health-related reasons.

In about 50% of cases, these tumors cause no symptoms, so many people don’t even know they have them until they show up on a scan. Although liver adenomas are benign, they can still cause problems, such as rupturing or becoming cancerous.

Symptoms

Liver adenomas often cause no symptoms and may go undetected for a long time. However, if they grow large enough or complications arise, some people may experience:

• Mild to severe abdominal pain in the right upper quadrant of the abdomen.
• Bloating

In rare cases, adenomas can rupture, causing symptoms such as:

• Severe abdominal pain
• Vomiting, often with blood.
• Blood in the stool
• frivolity

Liver adenoma and birth control: what is the connection?

Studies have shown a strong connection between the development of liver adenoma and the use of hormonal contraceptives, especially those containing higher doses of estrogen. In addition, stopping oral contraceptives often results in tumor regression.

Tumor formation

Studies have shown that long-term use of estrogen may increase the risk of developing liver tumors, including liver adenomas.

Three molecular pathways are involved in the development of hepatocellular adenoma:

• Inactivation of HNF1α: HNF1α acts as a “control switch” for liver cells. When this switch is turned off (inactivated), liver cells can grow too large and become abnormal, forming a tumor.
• Activation of β-catenin: In this pathway, a protein called β-catenin becomes overactive. This may occur due to mutations in the gene encoding β-catenin. When β-catenin is overactive, it promotes cell growth and division, promoting tumor formation.
• Inflammatory activation: This pathway is associated with liver inflammation, often associated with conditions such as obesity and excessive alcohol consumption. Inflammation can lead to changes in the behavior of liver cells, increasing the risk of tumor development.

Women taking oral contraceptives have the same risk of developing all three types of liver adenoma. Although there have been rare cases of liver adenoma developing into a more severe cancer called hepatocellular carcinoma (HCC), studies have not found conclusive evidence linking oral contraceptive use to an increased risk of HCC.

Other risk factors

In addition to hormonal influences, other factors may be associated with the development of liver adenoma, including:

• Drinking too much alcohol
• Obesity
• Metabolic syndrome
• Use of anabolic steroids

Awareness of these risk factors can help individuals and health care providers identify those who may benefit from regular monitoring.

Test and radiology results

When hepatic adenoma is suspected, imaging studies are critical for diagnosis and evaluation. Here are the main methods used in assessing liver lesions:

• Ultrasound: Often the first imaging modality used is ultrasound, which can help visualize liver lesions, including liver adenomas. These tumors usually appear as well-defined, homogeneous lesions.
• Magnetic resonance imaging (MRI): Magnetic resonance imaging (MRI) provides detailed images of liver lesions and helps differentiate liver adenomas from other types of tumors or lesions. Adenomas often show characteristic patterns, such as hyperintense signal on T1- or T2-weighted images.
• Computed tomography (CT): CT can provide additional information about the size and vascularity of the adenoma. Contrast-enhanced CT helps evaluate tumor characteristics and evaluate potential complications such as bleeding.

If a liver adenoma is diagnosed, additional imaging may be required to monitor its size and behavior over time. Regular imaging monitoring can ensure early detection of any changes.

Care

Treatment for liver adenoma depends largely on its size, symptoms, and the person’s overall health. Liver adenomas smaller than 5 centimeters (cm) in size and associated with oral contraceptive use are usually approached cautiously by health care providers. They may suggest stopping birth control pills and checking the tumor regularly with imaging tests such as ultrasound or MRI. In many cases, this can help the tumor shrink over time.

Most small adenomas do not change much during pregnancy, and women with such tumors are generally not discouraged from becoming pregnant.

When providers consider deleting

Surgery may be warranted under certain conditions, such as:

• Size: In women, the adenoma can be removed if it is larger than 5 cm. At this size, it can cause more serious problems.
• Suspicion of malignancy: If imaging raises concerns about the possibility of cancer, surgical removal is often recommended to ensure accurate diagnosis and treatment.

Surgery to remove an adenoma is usually recommended for all men, regardless of the size of the tumor. This is because men are more likely to have adenomas, which can cause cancer. Surgery to remove the tumor is considered a safe and effective treatment. However, this will only be done if necessary, since any operation carries some risk.

The main surgical options for treating liver adenoma are:

• Laparoscopic resection: This minimally invasive method involves removing the adenoma through small incisions. This usually results in faster recovery and less post-operative pain.
• Open surgery: In cases where the adenoma is particularly large or complex, open surgery may be required to completely remove it.

Transarterial embolization (TAE) is a medical procedure to treat liver adenoma when bleeding occurs within the tumor. This procedure blocks blood flow to the tumor, which helps stop bleeding. TAE is usually performed within two to three days after bleeding occurs, and may be followed by surgery to remove the tumor if necessary.

Recovery after surgery

Recovery from liver adenoma surgery can vary depending on the person’s overall health, the surgical technique used, and the size of the tumor. Here are some general recovery considerations:

• Hospital stay: Laparoscopic procedures usually require a shorter hospital stay (1–2 days) than open surgery (3–6 days).
• Activity restrictions: Patients may need to limit physical activity for several weeks after surgery to allow the liver to heal properly.

Relapse statistics

The outlook for people with hepatocellular adenoma (HCA) is not well understood. Stopping oral contraceptives can sometimes shrink or cure the swelling. Surgical resection can significantly reduce the likelihood of recurrence.

In a study of 118 people who had surgery to remove liver adenomas, 8% had tumors that returned or grew larger. In the 10 patients whose tumors became cancerous, there was no evidence of cancer returning after a mean follow-up of 78 months.

Summary

Liver adenomas are benign liver tumors that are primarily influenced by hormonal factors, especially estrogens. Although they are often asymptomatic, they can lead to serious complications, making awareness and monitoring critical. Early detection using imaging modalities such as ultrasound, MRI, and CT can facilitate timely intervention. Treatment options, including surgical removal, may be necessary depending on the size of the adenoma and symptoms present.

If you or a loved one has been diagnosed with liver adenoma, discussing your specific situation and treatment options with your healthcare provider is important to ensure the best outcome.