Hepatic adenoma among adult survivors of childhood cancer.

Abstract

117 Background: Hepatic adenoma is a rare and poorly understood benign epithelial neoplasm. Because of the potential for spontaneous hemorrhage, rupture, or malignant transformation; hepatic adenoma over 5 cm require resection. In the general population, the prevalence of hepatic adenoma is estimated at 1 in 100,000 and identified predominantly in obese females on oral contraceptives. An increased risk for hepatic adenoma among adult survivors of childhood and young adult cancer has not been previously reported Methods: Cancer diagnosis and treatment, as well as demographic factors, medications, and comorbidities, were collected from the medical chart among patients with pathological confirmation of hepatic adenoma. All cases were patients diagnosed with a non-hepatic cancer before the age of 40 and seen at Memorial Sloan Kettering Cancer Center. Results: Twelve cases of hepatic adenoma were pathologically confirmed; seven patients (58%) had more than one adenoma. Eleven (92%) cases were female. The most common preceding cancer diagnosis was leukemia (N = 4; 33%). Five (42%) had undergone allogeneic hematopoietic cell transplant with total body irradiation (TBI) as part of their preconditioning regimen. Cases were not as a rule obese; median body mass index was 22.2 kg/m2 (range, 17.6-31.0 kg/m2). All eleven females had a history of current or prior hormone therapy with estrogen and progesterone; the single male case was hypogonadal as a result of radiation therapy to the testes during treatment for acute myelogenous leukemia (AML) and was receiving testosterone therapy at the time of chart review. Eight patients (67%) had hypothyroidism and two (17%) were taking anti-epileptic drugs. Only two patients (17%) were monitored radiographically following biopsy; seven patients (58%) underwent hepatic resection and three (25%) underwent embolization. No patient had significant blood loss or has been observed to undergo malignant transformation, although follow-up is ongoing. Conclusions: Adult survivors of childhood and young adult cancer, particularly females with a history of current or prior hormone therapy, may be at increased risk for hepatic adenoma. Further investigation of this potentially morbid condition is warranted.