Adénomes hépatocellulaires hémorragiques : quels adénomes? Quelles implications thérapeutiques?

Résumé fourni par la source

Background and Aims: hepatocellular adenoma (HCA) is a rare benign liver tumor with severe complications: malignant transformation into hepatocellular carcinoma (HCC) which is rare (5-8%) and more often, hemorrhagic rupture (20-27%). To date, only size >5cm and shHCA subtype are associated with clinical bleeding, but these criteria are not sufficient to explain and prevent hemorrhage. Our aim was to determine independent risk and severity factors of hemorrhagic HCA in order to define a better management strategy. Approach and results: we retrospectively collected data from 267 patients with HCA diagnosed and follow-up from 1984 to 2020, at the Bordeaux university hospital, a tertiary center. We included 261 patients and we analyzed the type, frequency and consequences of bleeding HCA. All surgical specimen and liver biopsy were reviewed by an experienced liver pathologist and reclassified if necessary, in the light of the current knowledge. Severe bleeding occurred in 42 patients, including 4 pregnant women, with mean BMI of 27.9 kg/m2 (±7.3) and mean HCA size of 101.9mm (±37.3). We counted 178 patients without hemorrhage. We identified shHCA, mutated HCA on exon 7/8, size and chronic alcohol consumption as independent risk and severity factors. One patient died before treatment. Three patients had recurrent bleeding one of which occurred 4 months after transarterial embolization (TAE). Conclusion: hemorrhagic HCA is a real concern and could be life-threatening. Our study allowed us to identified shHCA and HCA mutated on CTNNB1 exon 7/8 as independent risk factors of clinical hemorrhage, prompting us to remove these lesions regardless of their size. Attention should be paid to alcohol consumption, also identified as impacting factor.

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