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Wednesday, January 23, 2008

Liver Adenoma

Etiology
  • The more common hepatocellular adenoma may be related to contraceptive use.
Epidemiology
  • Liver cell adenoma is common in young women and may be related to the use of oral contraceptive medications.
  • Bile duct adenomas are quite uncommon and may represent hamartomas or tumors due to developmental aberration.
General Description
  • Hepatic adenomas are of two histological types: liver cell and Bile duct type.
  • Liver cell adenomas are usually large when detected (25 - 30 centimeters in diameter), while bile duct adenomas are usually small, up to one centimeter in diameter.
  • Liver cell adenomas can occur anywhere in the liver tissue, but are quite often seen under the capsule.
  • Liver cell adenomas are usually pale to yellow in colour and may be bile stained.
  • They are usually well demarcated, but the capsule may not be clearly obvious
Microscopic Appearance
  • Histologically, a hepatocellular adenoma is composed of normal looking hepatocytes arranged in sheets and cords.
  • Significant evidence of bile deposition may be seen within and between the cells
  • Typical portal tracts and central veins are not seen, since the cells are not arranged in a typical lobular pattern.
  • Bile duct adenomas are composed of slit - like to circular spaces lined by epithelium that resembles noram bile duct epithelium.
  • However, significant vascular supply is a prominent feature.
Clinical features
  • Clinically, both liver cell adenimas and bile cell adenomas are noncancerous lesions with little clinical significance.
  • However, liver cell adenomas can become large sized during pregnancy, presumably as a result of estrogen stimulation
  • Under these circumstances liver cell adenomas can rupture resulting in acute bleeding and peritonitis.
Liver cell adenomas may reduce in size in young women once they stop oral contraceptive ingestion.

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