Obesity, metabolic comorbidities linked to large hepatocellular adenoma, adenomatosis

Obesity and metabolic comorbidities appear to be common among patients with large hepatocellular adenomas (HCAs) and adenomatosis, reports a study.

In addition, long-term adverse outcomes are sporadic, while tumour haemorrhage is seen in 5 percent of the patients, including one with malignant transformation.

HCA diagnosis in this study was performed based on a combination of clinical, radiologic, and histologic criteria. The researchers collected patient and clinical data, including follow-up imaging, complications, and interventions, between 2004 and 2018 from three large academic centres.

Of the 187 patients with HCA (163 female and 24 male), 75 had solitary HCA, 58 had multiple HCAs, and 54 had adenomatosis. Over a median 3.3 years of follow-up, 34 patients (18 percent) received radiologic interventions, 41 (21 percent) had surgical resections, 10 (5 percent) developed tumoural haemorrhage, and one had malignant transformation.

Seventy percent and 16 percent of patients used oral contraceptives and corticosteroids, respectively. Many patients also had obesity (51 percent), type 2 diabetes (24 percent), hypertension (42 percent), and hypertriglyceridaemia (21 percent). In patients with large HCAs and adenomatosis, metabolic comorbidities were frequent.

Notably, men had less hepatic steatosis (4 percent vs 27 percent), smaller HCAs (2.3 vs 4.4 cm), and more corticosteroid use (38 percent vs 11 percent) compared with women (p<0.05 for all). Among patients who ceased oral contraceptive use, 69 percent had a decrease in HCA size, but 25 percent eventually required advanced interventions.

“Beyond oral contraceptives, metabolic factors have been suggested to increase the risk of HCA,” the researchers said. “The impact of risks remains poorly defined, particularly among men and those with adenomatosis.”