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Case Reports
. 2019 Nov;8(4):266-270.
doi: 10.5582/irdr.2019.01089.

Malignant transformation of hepatic adenoma complicated by rupture and hemorrhage: An extremely rare clinical entity

Rishi Philip Mathew  1 , Florin Manolea  1 , Safwat Girgis  2 , Vimal Patel  1 , Gavin Low  1
Affiliations
Case Reports

Malignant transformation of hepatic adenoma complicated by rupture and hemorrhage: An extremely rare clinical entity

Rishi Philip Mathew et al. Intractable Rare Dis Res. 2019 Nov.

Abstract

Hepatic adenomas (HAs) are rare benign tumors of the liver and comprise 2% of all liver tumors with an annual incidence of 3-4/100,000 per year in Europe and North America. These tumors may be clinically silent or present with abdominal pain. Although rare, the most important complications associated with this tumor is haemorrhage and malignant transformation to hepatocellular carcinoma. The reported risk of malignant transformation is believed to be 4.2%. We present an extremely rare case report of a young woman on the oral contraceptive pill (OCP) with malignant transformation of a hepatic adenoma complicated additionally by tumor rupture and intraperitoneal bleed. This article therefore highlights the need to carefully evaluate any liver lesion in a young female on the OCP to be a possible adenoma and if confirmed to be so, to consider the potential risks associated with it as well as the need for follow-up imaging in order to avoid life threatening complications.

Keywords: Hepatic adenoma; hemorrhage; hepatocellular carcinoma; inflammatory adenoma; malignant transformation; oral contraceptive pill.

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Figures

Figure 1.
Figure 1.
Ultrasound of the abdomen revealed a poorly defined non-vascular hypoechoic lesion (A) in the right lobe of the liver close to the liver capsule. Additionally, turbid free fluid was noted in the pelvis in the right lower quadrant (B) in the posterior cul-de-sac raising the possibility of intrabdominal hemorrhage.
Figure 2.
Figure 2.
Non-contrast coronal reformatted CT image (A), showing non-cirrhotic liver with a 10 cm hyperdense lesion occupying the majority of the right lobe of the liver, in addition, subcapsular hematoma involving the right lobe of the liver as well as adjacent intraperitoneal hemorrhage into the right subphrenic space as well as into the peritoneal cavity was also identified. Post contrast coronal reformatted CT image (B) showing peripheral areas of soft tissue enhancement were demonstrated in a patchy distribution. In addition, a liver capsule defect was clearly visible, confirming lesion rupture and subsequent intraperitoneal hemorrhage.
Figure 3.
Figure 3.
The adenoma at 100× (A), section shows liver parenchyma with no intervening portal tracts and normal trabecular pattern, one to two cell width. The HCC 200× (B), section shows liver parenchyma with visible marked atypia and patchy expanded trabeculae. Retic interface (C), section shows preservation of normal reticulin pattern in the adenomatous area while the malignant area shows reticulin loss. CD34 (D), sections positive expression of CD34 indicative of arterialization of the sinusoids. Negative Glypican3 (E), section shows malignant area with no expression of Glypican3. Negative Beta Catenin (F), sections shows malignant area with no expression of Beta Catenin.
See this image and copyright information in PMC

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