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Hepatocellular adenoma

1. °³¿ä : 20-30´ë ¿©¼º¿¡¼­ È£¹ßÇÏ´Â ¾ç¼º °£Á¾¾çÀ¸·Î ¿©¼º¿¡¼­ È£¹ßÇÏ´Â °ÍÀ¸·Î º¸¾Æ

È£¸£¸óÀÌ º´Àο¡ °ü¿©ÇÏ´Â °ÍÀ¸·Î »ý°¢µÇ¸ç °æ±¸ÇÇÀÓÁ¦°¡ ¿øÀÎÀû ¿ªÇÒÀ» ÇÑ´Ù.

anabolic steroids, androgen»ç¿ë ȯÀÚ¿¡¼­ ºóµµ°¡ Áõ°¡ÇÑ´Ù.

multiple hepatic adenomas´Â glycogen storage disease I°ú °ü·ÃÀÖ´Ù.

Right lobe¿¡ È£¹ßÇϸç, multiple, 10cm ÀÌ»óÀ¸·Î Ä¿Áú¼öµµ ÀÖ´Ù.

Çö¹Ì°æÀûÀ¸·Î Á¤»ó ȤÀº ¾à°£ atypical hepatocyte·Î ±¸¼º.

(cell- glycogenÀÌ Ç³ºÎÇϸç paler & larger)

2. ÀÓ»óÁõ»ó : pain, palpable mass, intratumor hemorrhage

3. Áø´Ü : USG, CT, MRI, selective hepatic arteriography, radionuclide can

Áø´ÜÀº ÀÌ¿Í °°Àº ´Ù¾çÇÑ °Ë»çµéÀÇ Á¶ÇÕÀ¸·Î ÀÌ·ç¾îÁø´Ù.

i) Angiography: ÀüÇüÀûÀ¸·Î´Â hypervascularÇÏÁö¸¸ hypovascular regionµµ Æ÷ÇԵǾî ÀÖ´Ù.

ii) 99mTc scan: defect(cold spot)·Î ³ªÅ¸³ª´Âµ¥ ÀÌ´Â hepatic adenoma¿¡´Â Kupffer cellÀÌ

¾ø±â ¶§¹®ÀÌ´Ù.

iii) MRI : HCC¿Í ¸¶Âù°¡Áö·Î T1-intense appearance

4. Malignant risk´Â ÀûÁö¸¸ 10cmÀÌ»óÀ̰í multiple adenomaÀÏ ¶§ À§Çèµµ°¡ Áõ°¡ÇÑ´Ù.

5. Ä¡·á ¨ç small tumor - imaging surveillence

¨è 8-10cm - op

¨é oral contraceptives stop -> Áß´ÜÈÄ¿¡µµ size°¡ ÁÙÁö ¾ÊÀ¸¸é ¼ö¼úÀû ÀýÁ¦°¡

ÇÊ¿äÇÒ¼öµµ ÀÖ´Ù.

¨ê pregnacy¶§´Â hemorrhage risk°¡ Áõ°¡Çϸç large adenomaȯÀÚ¿¡¼­´Â ÀÓ½ÅÀ»

ÇÇÇØ¾ß ÇÑ´Ù.

¨ë multiple larger adenoma(glycogen-storage disease) - liver transplantation

Focal nodular hyperplasia(FNH)

FNH´Â ¾ç¼º Á¾¾çÀÌ¸ç °Ë»ç ¶Ç´Â ´Ù¸¥ ÀÌÀ¯·Î º¹°­°æ °Ë»çÁß ¿ì¿¬È÷ ¹ß°ßµÈ´Ù.

hepatic adenomaó·³ ¿©ÀÚ¿¡ ÁÖ·Î »ý±âÁö¸¸ °æ±¸ ÇÇÀÓÁ¦¿Í´Â °ü·Ã ¾ø°í hemorrhage &

necrosisµµ µå¹°´Ù. ÃâÇ÷ À§Ç輺Àº °æ±¸ ÇÇÀÓÁ¦¸¦ º¹¿ëÇÏ´Â ¿©¼º¿¡¼­ ´õ ³ô´Ù.

ÀüÇüÀûÀ¸·Î ÀÌ º´º¯Àº solid tumorÀ̸ç ÁÖ·Î right lobe¿¡ »ý±â°í, fibrous core & stellate

projections ÇÑ´Ù.

fibrous projection¿¡´Â atypical hepatocytes, biliary epithelium, Kupffer cells, and

inflammatory cellsµé Æ÷ÇԵǾî ÀÖ´Ù. 99mTc scanÀ» Çϸé hot spotÀ¸·Î ³ªÅ¸³ª´Âµ¥ ÀÌ´Â

Kupffer cellÀÌ Á¸ÀçÇϱ⠶§¹®ÀÌ´Ù.

angiography»ó vascularÇϸç, helical CT(º¸´Ù MRI°¡ ´õ reliable)¿¡¼­´Â septationÀÌ °üÂûµÉ

¼öµµ ÀÖ´Ù. ÃÊÀ½ÆÄ·Î´Â septation°üÂûÀº µå¹°´Ù.

Áõ»óÀÌ ÀÖ´Â °æ¿ì¿¡¸¸ ¼ö¼úÀÌ ÀûÀÀµÈ´Ù.

Hemangioma and other benign tumors

hemangioma´Â °¡Àå ÈçÇÑ ¾ç¼º °£Á¾¾çÀ¸·Î ¿©ÀÚ¿¡ ¸¹°í º¸Åë ¿ì¿¬È÷ ¹ß°ßµÈ´Ù.

Àüü Àα¸Áß À¯º´·üÀº 0.5-7%Á¤µµÀÌ´Ù.

asymptomatic vascular lesionÀ̸ç MRI³ª contrast-enhanced CT, labeled RBC nuclide

scan, or hepatic angiography·Î ¹ß°ßÇÒ¼ö ÀÖ´Ù.

Å©±â°¡ Ä¿¼­ mass effect¸¦ ³ªÅ¸³»Áö ¾Ê´ÂÇÑ Á¦°ÅÇÒ Çʿ䰡 ¾ø´Ù. ÃâÇ÷Àº µå¹°°ú malignant

change´Â ÀϾÁö ¾Ê´Â´Ù.

Nodular regenerative hyperplasia´Â periportal hepatocyte regeneration with surrounding

atrophy·Î ÀÎÇÑ multiple hepatic nodules·Î ÀÌ·ç¾îÁø´Ù. malignancy or connective tissue

diseae¿Í °ü·ÃÀÖ´Ù.

portal hypertensionÀÌ °¡Àå ÈçÇÑ ÀÓ»ó¹ßÇöÀÌ´Ù.

´Ù¸¥ ´ú ÈçÇÑ ¾ç¼ºÁ¾¾çÀ¸·Î´Â bile duct adenoma & cystadenoma°¡ ÀÖ´Ù.