When a patient presents with ten or more hepatic adenomas, the condition is classified as hepatic adenomatosis — a distinct variant of hepatic cell adenoma that carries specific management implications due to its multifocal burden.
Hepatic adenomatosis is defined by the presence of multifocal (>10) hepatic adenoma nodules. It is more commonly associated with background steatosis or glycogen storage disease. The multifocal nature of the disease, and whether involvement is unilobar or bilobar, directly shapes the treatment strategy.
Management involves surgical intervention directed at the most dominant or concerning lesion, alongside systemic lifestyle-based strategies. The specific approach depends on lesion distribution and individual risk factors. The complete protocol — including intervention criteria, sequencing, and the full scope of systemic management — is available via the structured regimen.
DOI: 10.14309/ajg.0000000000002857
Hepatic adenomatosis is a variant of HCA characterized by 10 or more hepatic adenomas, more commonly associated with background steatosis or glycogen storage disease.
The presence of multifocal (>10) nodules has been defined as adenomatosis.
Unilobar disease can be managed with surgical resection or resection of a dominant larger adenoma.
In the setting of bilobar involvement, management is best focused on treating the largest or dominant lesion or any that raise suspicion for complications such as hemorrhage or malignant transformation.
Lifestyle modification including removal of exogenous hormone therapy, and metabolic risk factor management, has been shown to reduce the overall burden and size of multiple HCAs.
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