Intrahepatic huge hematoma due to rupture of small hepatocellular adenoma: a case report

Minami, Yasunori; Kudo, Masatoshi; Kawasaki, Toshihiko; Chung, Hobyung; Matsui, Shigenaga; Kitano, Masayuki; Suetomi, Yoichiro; Onda, Hirokazu; Funai, Sadao; Kou, Kenzou; Yasutomi, Masayuki

doi:10.1016/s1386-6346(01)00164-4

Cited by 12 publications

(9 citation statements)

References 4 publications

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“…[5][6][7] HA are not malignant tumours, but surgical intervention may be required if sudden massive bleeding or liver failure occurs; rupture of HA with haemoperitoneum can be a life threatening complication. [8][9][10][11] HA are hypervascular tumours containing multiple sinusoids of capillaries with thin walls in which the pressure is exclusively arterial. The connective tissue support is poor and, therefore, bleeding tends to spread diffusely throughout the entire tumour.…”

Section: Discussionmentioning

confidence: 99%

“…8 17 In a number of cases, other therapies, such as ethanol injection therapy or radiofrequency ablation, should also be evaluated. 8 Thus, young men with HA should undergo tumour resection, even when there is no liver failure, rupture, or malignant transformation. However, in the cases here reported hepatic resection has not been performed because of the size and number of the tumours.…”

Section: Discussionmentioning

confidence: 99%

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Hepatocellular adenomas associated with anabolic androgenic steroid abuse in bodybuilders: a report of two cases and a review of the literature

Socas¹,

et al. 2005

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Anabolic androgenic steroids (AAS) are used illicitly at high doses by bodybuilders. The misuse of these drugs is associated with serious adverse effects to the liver, including cellular adenomas and adenocarcinomas. We report two very different cases of adult male bodybuilders who developed hepatocellular adenomas following AAS abuse. The first patient was asymptomatic but had two large liver lesions which were detected by ultrasound studies after routine medical examination. The second patient was admitted to our hospital with acute renal failure and ultrasound (US) studies showed mild hepatomegaly with several very close hyperecogenic nodules in liver, concordant with adenomas at first diagnosis. In both cases the patients have evolved favourably and the tumours have shown a tendency to regress after the withdrawal of AAS. The cases presented here are rare but may well be suggestive of the natural course of AAS induced hepatocellular adenomas. In conclusion, sportsmen taking AAS should be considered as a group at risk of developing hepatic sex hormone related tumours. Consequently, they should be carefully and periodically monitored with US studies. In any case, despite the size of the tumours detected in these two cases, the possibility of spontaneous tumour regression must also be taken in account.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hepatocellular adenomas associated with anabolic androgenic steroid abuse in bodybuilders: a report of two cases and a review of the literature

Socas¹,

et al. 2005

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“…It has been suggested that adenomas greater than 5 cm in diameter should be excised as they are at increased risk of bleeding [49]. However, Flowers [50] and Minami [51] reported patients with massive bleeding from adenomas of only 3.5 cm diameter, with one patient fatality in the postoperative period. In contrast, other patients with large adenomas have been observed for prolonged periods without evidence of bleeding.…”

Section: Complications and Management Of Solitary Liver Cell Adenomamentioning

confidence: 99%

Liver cell adenoma and liver cell adenomatosis

Barthelmes

Tait

2005

HPB

117

151

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During the last three decades liver cell adenoma and liver cell adenomatosis have emerged as new clinical entities in hepato-logical practice due to the widespread use of oral contraceptives and increased imaging of the liver. On review of published series there is evidence that 10% of liver cell adenomas progress to hepatocellular carcinoma, diagnosis is best made by open or laparoscopic excision biopsy, and the preferred treatment modality is resection of the liver cell adenoma to prevent bleeding and malignant transformation. In liver cell adenomatosis, the association with oral contraceptive use is not as high as in solitary liver cell adenomas. The risk of malignant transformation is not increased compared with solitary liver cell adenomas. Treatment consists of close monitoring and imaging, resection of superficially located, large (>4 cm) or growing liver cell adenomas. Liver transplantation is the last resort in case of substantive concern about malignant transformation or for large, painful adenomas in liver cell adenomatosis after treatment attempts by liver resection.

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“…HA is a rare benign hepatic neoplasm that is of interest for at least three reasons: (1) it may be difficult to distinguish from other benign or malignant hepatic tumors; (2) it may undergo malignant transformation and (3) it has a marked tendency to hemorrhage 18–21. HA is notoriously difficult to diagnose pre-operatively by clinical, radiographic, or histological means.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Spontaneous Ruptured Hepatocellular Adenoma

Ribeiro

Chaib

Saad

et al. 2009

Clinics

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AIMSSpontaneous ruptured hepatocellular adenoma (SRHA) is a rare life-threatening condition that may require surgical treatment to control hemorrhaging and also stabilize the patient. We report a series of emergency surgeries performed at our institution for this condition.METHODSWe reviewed medical records and radiology files of 28 patients (from 1989 to 2006) with a proven diagnosis of hepatocellular adenoma (HA). Three (10.7%) of 28 patients had spontaneous ruptured hepatocellular adenoma, two of which were associated with intrahepatic hemorrhage while one had intraperitoneal bleeding. Two patients were female and one was male. Both female patients had a background history of oral contraceptive use. Sudden abdominal pain associated with hemodynamic instability occurred in all patients who suffered from spontaneous ruptured hepatocellular adenoma. The mean age was 41.6 years old. The preoperative assessment included liver function tests, ultrasonography and computed tomography.RESULTSThe surgical approaches were as follows: right hemihepatectomy for controlling intraperitoneal bleeding, and right extended hepatectomy and non-anatomic resection of the liver for intrahepatic hemorrhage. There were no deaths, and the postoperative complications were bile leakage and wound infection (re-operation), as well as intraperitoneal abscess (re-operation) and pleural effusion.CONCLUSIONSpontaneous ruptured hepatocellular adenoma may be treated by surgery for controlling hemorrhages and stabilizing the patient, and the decision to operate depends upon both the patient’s condition and the expertise of the surgical team.

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Intrahepatic huge hematoma due to rupture of small hepatocellular adenoma: a case report

Cited by 12 publications

References 4 publications

Hepatocellular adenomas associated with anabolic androgenic steroid abuse in bodybuilders: a report of two cases and a review of the literature

Hepatocellular adenomas associated with anabolic androgenic steroid abuse in bodybuilders: a report of two cases and a review of the literature

Liver cell adenoma and liver cell adenomatosis

Surgical Management of Spontaneous Ruptured Hepatocellular Adenoma

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