title: Clinical features and natural history of hepatocellular adenomas: the impact of obesity.
abstract: BACKGROUND
  Hepatocellular adenoma is a benign tumour associated with bleeding and malignant transformation. Obesity has been linked to hepatic tumourigenesis.
  
  
  OBJECTIVE
  To evaluate the presentation of hepatocellular adenoma in obesity, and the impact of obesity on the clinical course.
  
  
  METHODS
  Records of 60 consecutive patients (between 2005 and 2010) with a diagnosis of hepatocellular adenoma from a single tertiary centre were analysed.
  
  
  RESULTS
  Fifty six of 60 patients were women, median age was 36years, 75% had history of contraceptive use, 18% were overweight and 55% were obese (BMI ≥30kg/m(2) ). Majority (63%) were asymptomatic; seven patients presented with bleeding. Single (28%) and multiple adenomas (72%) were encountered; size ranged from 1 to 19.7cm. Obesity was more often associated with multiple adenomas (85% vs. 48%, P=0.005), bilobar distribution (67% vs. 33%, P=0.01), lower serum albumin (P=0.007) and co-morbidities of fatty liver (P=0.006), diabetes (P=0.003), hypertension (P=0.006) and dyslipidemia (P=0.03). During median follow-up of 2.6years, there were no instances of bleeding, malignant transformation or death. Thirty four patients underwent therapeutic intervention (17 surgical resection, nine transarterial embolization and eight both interventions sequentially). The rate of complete resection of adenoma(s) was significantly lower in obese patients (8% vs. 69%, P=0.004). In the 26 patients without intervention, tumour size progression was more frequently observed in obese patients (33% vs. 0%, P=0.05). Three of 15 obese patients (20%) lost ≥5% body weight and there was no progression in the liver lesions.
  
  
  CONCLUSIONS
  Obesity and features of metabolic syndrome were frequently observed in hepatocellular adenoma. Multiple and bilobar adenomas were more frequent in obese patients. Among patients who were conservatively managed, tumour progression was more often associated with obesity.
authors.affiliation: Division of Gastroenterology and Hepatology and Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: C
authors.initials: C
authors.lastname: Bunchorntavakul
authors.forename: R
authors.initials: R
authors.lastname: Bahirwani
authors.forename: D
authors.initials: D
authors.lastname: Drazek
authors.forename: M C
authors.initials: MC
authors.lastname: Soulen
authors.forename: E S
authors.initials: ES
authors.lastname: Siegelman
authors.forename: E E
authors.initials: EE
authors.lastname: Furth
authors.forename: K
authors.initials: K
authors.lastname: Olthoff
authors.forename: A
authors.initials: A
authors.lastname: Shaked
authors.forename: K R
authors.initials: KR
authors.lastname: Reddy
mesh_terms: D018248:Adenoma, Liver Cell / Q000473:pathology* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000628:therapy; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000175:diagnosis; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D012189:Retrospective Studies; D055815:Young Adult