From an Incidental Finding to an Emergent Treatment: A Case Report of a Hepatic Adenomatosis and Large Ruptured Hepatic Adenoma

Abstract

Introduction. Hepatic adenoma is an uncommon benign liver tumor presenting as solitary lesions or even rarely as hepatic adenomatosis. Large lesions carry a risk of rupture, hemorrhage, and malignant transformation. This case report aims to increase awareness about risk factors for hepatic adenomas, considering the increasing prevalence of obesity and the widespread use of oral contraceptive pills. Case Presentation. A 20-year-old obese female who was taking oral contraceptive pills for seven years presented to the emergency department with vomiting and abdominal pain caused by gastroenteritis. On imaging, multiple hepatic adenomas, including two lesions 6 and 9 cm in diameter, were incidentally found. During the hospitalization, the patient suddenly developed acute anemia and rupture of the largest lesion, which was promptly treated with arterial embolization. Discussion. Obesity and exposure to hormones are well-known risk factors for hepatic adenomas. The incidence of hepatic adenomas is steadily increasing because of the prevalence of obesity, especially among females. Lifestyle interventions for weight loss and discontinuation of oral contraceptive pills are considered a conservative treatment of hepatic adenomas. Large lesions possess the risk of malignant transformation and rupture and require surgical excision.

A Rare Presentation of Multiple Hepatic Masses Due to Hepatic Adenoma: A Case Report

“… 8 The use of OCPs for 5 to 7 years carries a 5-fold risk of HA development while use of OCPs for 9 years or more leads to a 25-fold risk of HA development. 3 Discontinuation of OCPs usually leads to at least a 30% decrease in tumor size in 40% of patients. 9 Patients whose HAs are unresponsive to conservative management will require surgical resection.…”

“… 2 Lesions larger than 5 cm occur in less than 20% of cases. 3 Such large lesions have a higher chance of malignant transformation, rupture, and spontaneous hemorrhage. 2 The incidence of HAs significantly rises with the use of oral contraceptive pills (OCPs) and in patients who are obese.…”