Malignant transformation of hepatocellular adenomas into hepatocellular carcinomas: a systematic review including more than 1600 adenoma cases

J.H.M.B. Stoot, R.J. Coelen, M.C. de Jong, C.H.C. Dejong

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Malignant transformation of hepatocellular adenomas (HCAs) into hepatocellular carcinomas (HCCs) has been reported repeatedly and is considered to be one of the main reasons for surgical treatment. However, its actual risk is currently unknown. OBJECTIVE: To provide an estimation of the frequency of malignant transformation of HCAs and to discuss its clinical implications. METHODS: A systematic literature search was conducted using the following databases: The Cochrane Hepatobiliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, MEDLINE and EMBASE. RESULTS: One hundred and fifty-seven relevant series and 17 case reports (a total of 1635 HCAs) were retrieved, reporting an overall frequency of malignant transformation of 4.2%. Only three cases (4.4%) of malignant alteration were reported in a tumour smaller than 5 cm in diameter. DISCUSSION: Malignant transformation of HCAs into HCCs remains a rare phenomenon with a reported frequency of 4.2%. A better selection of exactly those patients presenting with an HCA with an amplified risk of malignant degeneration is advocated in order to reduce the number of liver resections and thus reducing the operative risk for these predominantly young patients. The Bordeaux adenoma tumour markers are a promising method of identifying these high-risk adenomas.
Original languageEnglish
Pages (from-to)509-522
Number of pages14
JournalHPB
Volume12
Issue number8
DOIs
Publication statusPublished - Oct 2010

Keywords

  • hepatocellular adenoma
  • liver adenoma
  • malignant transformation
  • hepatic adenoma
  • frequency
  • hepatocellular carcinomas
  • LIVER-CELL ADENOMA
  • FOCAL NODULAR HYPERPLASIA
  • ORAL-CONTRACEPTIVE USE
  • BENIGN HEPATIC-LESIONS
  • SINGLE-CENTER EXPERIENCE
  • OF-THE-LITERATURE
  • DISEASE TYPE IA
  • DIFFERENTIAL-DIAGNOSIS
  • SURGICAL-MANAGEMENT
  • SPONTANEOUS RUPTURE

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