TY  - BOOK
AU  - Desale, Sameer
AU  - Fernandez, Stephen
AU  - McDermott, Chelsea
TI  - Risk factors for bleeding hepatocellular adenoma in a United States cohort
SN  - 1478-3223
PY  - 2022///
KW  - *Adenoma, Liver Cell
KW  - *Carcinoma, Hepatocellular
KW  - *Liver Neoplasms
KW  - Adenoma, Liver Cell/co [Complications]
KW  - Adenoma, Liver Cell/di [Diagnosis]
KW  - Adenoma, Liver Cell/ep [Epidemiology]
KW  - Carcinoma, Hepatocellular/ep [Epidemiology]
KW  - Carcinoma, Hepatocellular/pa [Pathology]
KW  - Hedgehog Proteins
KW  - Humans
KW  - Liver Neoplasms/pa [Pathology]
KW  - Magnetic Resonance Imaging
KW  - Retrospective Studies
KW  - Risk Factors
KW  - United States/ep [Epidemiology]
KW  - MedStar Health Research Institute
KW  - MedStar General Surgery Residency
KW  - MedStar Georgetown University Hospital/MedStar Washington Hospital Center
KW  - Journal Article
N2  - BACKGROUND & AIMS: Known risk factors for hepatocellular adenoma (HCA) bleeding are size >5 cm, growth rate, visible vascularity, exophytic lesions, beta-catenin and Sonic Hedgehog activated HCAs. Most studies are based on European cohorts. The objective of this study is to identify additional risk factors for HCA bleeding in a US cohort; CONCLUSIONS: In a large US cohort, size predicted increased risk of HCA bleeding while hepatic adenomatosis trended towards increased risk of bleeding. In patients with multiple HCAs, size predicted bleeding and hepatic steatosis trended toward increased risk of bleeding. Copyright ♭ 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd; METHODS: Retrospective chart review was performed on patients diagnosed with HCA on magnetic resonance imaging (n = 184) at an academic tertiary institution. Clinical, pathological, and imaging data were collected. Primary outcomes measured were HCA bleeding and malignancy. Statistical analysis was performed with SAS 9.4 using Chi-Square, Fisher's exact test, sample t test, non-parametric Wilcoxon test, and logistic regression; RESULTS: After excluding patients whose pathology showed focal nodular hyperplasia and non-adenoma lesions, follow-up data were available for 167 patients. 16% experienced microscopic or macroscopic bleeding and 1.2% had malignancy. HCA size predicted bleeding (P < .0001) and no patients with lesion size <1.8 cm bled. In unadjusted analysis, hepatic adenomatosis (>=10 lesions) trended towards 2.8-fold increased risk of bleeding. Of patients with a single lesion that bled, 77% bled from a lesion >5 cm. In patients with multiple HCAs that bled, 50% bled from lesions <5 cm. In patients with multiple adenomas, size (P = .001) independently predicted bleeding and hepatic steatosis trended towards increased risk of bleeding (P = .05)
UR  - https://dx.doi.org/10.1111/liv.15087
ER  -