Revista ABCd (São Paulo). 25 Nov, 2015


Luis Eduardo Veras PINTO
João Paulo Ribeiro SILVA
Gustavo Coêlho RÊGO
José Huygens Parente GARCIA
DOI: 10.1590/S0102-6720201500030022


Hepatocellular adenoma (HA) is a rare benign neoplasm of the liver. It is strongly associated with oral contraceptive used by woman in childbearing age, by men receiving anabolic steroids and metabolic diseases. HA incidence has raised over the years from 5 per 1 milion in 19649 to 4 per 100.0003 , for unknown reasons.

HA is important because of its risk of complications such as life threatening rupture of the tumor and malignant transformation. Surgical treatment in ruptured HA has a high mortality rate but it is still the standard procedure in those cases5. Emergency liver resection in ruptured HA has a mortality rate from 5-10%, but in elective resections the mortality rate is under 1%.

Different procedures have been suggested to decrease mortality rates and spare liver parenchyma, such as arterial embolization of ruptured adenomas, although it is not an available procedure in most centers.


A 44-year-old woman admitted in the emergency department of another hospital with complaints of sudden upper quadrant abdominal pain. She had been using oral contraceptives for 31 years. She presented with acute mild abdominal pain in epigastrium as well as right hypochondrium pain followed by light dyspnea and dizziness. She was treated with analgesics and ordered an abdominal ultrasound made only three days after the pain. The ultrasound showed a solid liver mass in the right hepatic lobe measuring 150x100x100 mm3. She was discharged without additional treatment.

After almost five months after the occurrence, she was referred to our surgical department for diagnostic investigation after another episode of abdominal pain just like the last time, followed by tachycardia and cold sweating. Physical examination revealed mild anemia and a diffuse abdominal pain, without peritonitis or palpable masses.

Lab exams showed 8.61g/dl haemoglobin, white blood count 8.980/mm3 and 214.00 platelets. Liver transaminases level were altered: ALT 306 IU/l, AST 154 IU/l, alkaline phosphatase 142 IU/l and gamma-glutamyl transferase 229 IU/l. Alfa-fetoprotein and clotting functions were normal.

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