Published online Apr 27, 2019. doi: 10.4240/wjgs.v11.i4.229
Peer-review started: February 25, 2019
First decision: March 11, 2019
Revised: March 26, 2019
Accepted: April 23, 2019
Article in press: April 23, 2019
Published online: April 27, 2019
Processing time: 61 Days and 12.1 Hours
Hepatocellular adenoma (HCA) is a rare benign liver tumor usually affecting young women with a history of prolonged use of hormonal contraception. Although the majority is asymptomatic, a low proportion may have significant complications such as bleeding or malignancy. Despite responding to the hormonal stimulus, the desire for pregnancy in patients with small HCA is not contraindicated. However, through this work we demonstrate that intensive hormonal therapies such as those used in the treatment of infertility can trigger serious complications
A 33-year-old female with a 10-year history of oral contraceptive use was diagnosed with a hepatic tumor as an incidental finding in an abdominal ultrasound. The patient showed no symptoms and physical examination was unremarkable. Laboratory functional tests were within normal limits and tests for serum tumor markers were negative. An abdominal magnetic resonance imaging (MRI) was performed, showing a 30 mm × 29 mm focal lesion in segment VI of the liver compatible with HCA or Focal Nodular Hyperplasia with atypical behavior. After a total of six years of follow-up, the patient underwent ovulation induction treatment for infertility. On a following MRI, a suspected malignancy was warned and hence, surgery was decided. The surgical specimen revealed malignant transformation of HCA towards trabecular hepatocarcinoma with dedifferentiated areas. There was non-evidence of tumor recurrence after three years of clinical and imaging follow-up.
HCAs can be malignant regardless its size and low-risk appearance on MRI when an ovultation induction therapy is indicated.
Core tip: As far as we know, this is the first report of a case involving a young woman with a small hepatocellular adenoma (HCA) with a stable behavior in a 6-year follow-up, who developed imaging changes suggesting malignancy after performing ovulation induction treatment. The patient underwent surgery due to diagnostic uncertainty, and the pathology report confirmed its malignancy. Therefore, we conclude that HCAs can be malignant regardless its size and low-risk appearance on magnetic resonance imaging when a hormone therapy is indicated.