Title:
Risk factors for bleeding in hepatocellular adenoma.
Short:
Risks for bleeding in HCA
Authors:
Matthanja Bieze, M.D.1
Saffire S.K.S. Phoa, M.D. PhD2
Joanne Verheij, MD PhD3
Krijn P. van Lienden, MD PhD4
Thomas M. van Gulik, MD PhD1
Affiliations:
1
Department of Surgery, Academic Medical Center, the Netherlands
2
Department of Radiology, Academic Medical Center, the Netherlands
3
Department of Pathology, Academic Medical Center, the Netherlands
4
Department of Interventional Radiology, Academic Medical Center, the
Netherlands
Contact information of the first and corresponding author:
M. Bieze, MD, research fellow
Academic Medical Center
IWO 1-A1-132, Meibergdreef 9
1105 AZ Amsterdam, the Netherlands
Tel:
+31 20 5666653
Fax:
+31 20 6976621
E-mail: M.Bieze@amc.uva.nl
Article type: Original article
Conflicts of Interest and Source of Funding:
There are no conflicts of interest and no financial support or grant contributed to this study.
Risks for bleeding in HCA
Hepatocellular adenoma (HCA) is a benign hepatic lesion known with sometimes severe
bleeding complications, but the risk for bleeding is still ill defined. We aimed to assess risk
factors for bleeding in patients diagnosed with HCA and during follow-up.
Methods:
Patients with HCA were prospectively included from January2008 until July2012. Case
characteristics were noted; including body-mass-index (BMI), oral contraceptive use, and
pregnancy. All patients underwent dynamic MR and/or CT imaging at presentation and during
follow-up. Lesion characteristics on (follow-up) imaging were noted, and bleeding was
graded as intratumoral (Grade I), intrahepatic (Grade II), and extrahepatic (Grade III).
Standard of reference for diagnosis was histopathology, or dynamic MR and/or CT imaging.
Results:
In 45 patients included (mean age 40 years; 22-60 years, female/male 44:1), a total of 201
lesions were evaluated. Bleeding was seen in 29/45(64%) patients and in 46/201(23%) lesions
with a mean size of 43mm (6-160mm). Lesions >35mm showed a higher rate of bleeding
compared to lesions <35mm. Lesions in segment 2-3 showed more bleeding compared to
lesions located elsewhere (11/31; 35% versus 30/164; 18%: P = .05). Exofytic lesions showed
a higher incidence of bleeding (17/25;68%:P<.001) compared to intrahepatic (10/85;12%)
and subcapsular lesions (19/91;21%). When lesions exhibited peripheral or central arteries,
the lesions were more likely to show bleeding (10/12;P<.001). Patients with BMI>25 showed
an increased risk for high grade bleeding Grade II and III (13/35 versus 1/11;P=.03). Bleeding
occurred more often in steatotic compared to inflammatory HCA (4/7;57% versus 11/31;35%:
P=.018). Mean decrease in lesion size over time was 25% in 15 months (lesions n=122).
Conclusion:
Risk factors for bleeding of HCA include size >35mm, BMI (>25), presence of lesional
arteries, location in the left lateral liver, exofytic growth, and steatotic HCA.