Abstract
Background Hepatic adenomas (HA) are rare, benign proliferations of hepatocytes with high glycogen and fat content that lack normal hepatic architecture. In general, the long-term incidence of malignant degeneration to HCC has not been well characterized. This case report discusses a 37 male with a 10-year history of weekly anabolic steroid abuse who presented with bilobar hepatic adenomas with subsequent malignant degeneration to hepatocellular carcinoma (HCC). Case Presentation Our patient is a 37 old male with a 10-year history of weekly anabolic steroid abuse who presented to his primary care physician (PCP) in July 2013 with intermittent right upper quadrant (RUQ) pain. He was subsequently referred to our cancer center after abdomen/pelvis computed tomography (CT A/P) with oral and intravenous (IV) contrast at an outside hospital revealed two large hepatic masses. The larger mass in segment 2 measured 6.5 x 9.1 cm, while the segment 6/7 mass measured 7.5 x 7.6 cm. Abdomen magnetic resonance imaging (MRI) with and without IV contrast performed at our institution on July 23, 2013 confirmed the presence of the two above noted masses, which were felt to be consistent with probable HA, although HCC could not be definitely ruled out. Of note, his carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP) were within normal limits. Percutaneous, ultrasound-guided (US) biopsy of the left lobe mass was consistent with probable HA, although HCC could not be definitely ruled out. Conclusion We present the case of a 37-year-old male 10-year history of weekly anabolic steroid abuse who presented to us in 2013 with HA which had malignant degeneration to HCC while on surveillance over a 2-year period. This case report stresses the importance of having a high clinical suspicion for HA in patients with a history of anabolic steroid abuse and liver masses. Additionally, it reiterates that it can be difficult to differentiate HA from well-differentiated HCC on imaging and/or with a limited biopsy. Furthermore, it is important to keep in mind that the growth of a mass, especially off steroids is highly concerning for malignancy (and masses that fail to regress completely can harbor occult HCC).
Highlights
Hepatic adenomas (HA) are rare, benign proliferations of hepatocytes with high glycogen and fat content that lack normal hepatic architecture
The long-term incidence of malignant degeneration to HCC has not been well characterized. This case report discusses a 37 male with a 10year history of weekly anabolic steroid abuse who presented with bilobar hepatic adenomas with subsequent malignant degeneration to hepatocellular carcinoma (HCC)
Case Presentation Our patient is a 37 old male with a 10-year history of weekly anabolic steroid abuse who presented to his primary care physician (PCP) in July 2013 with intermittent right upper quadrant (RUQ) pain
Summary
HAs are rare, benign proliferations of hepatocytes with high glycogen and fat content that lack normal hepatic architecture. The mass straddling segment 6/7 is hypointense with areas of isointensity on the short echo time images and hyperintense on the long echo time images They do not demonstrate restricted diffusion and demonstrate early arterial enhancement with delayed washout. HCC associated with HA, or in lesions between HCC and HA, was found in 46% of β-catenin-mutated tumors but was not seen in inflammatory tumors and rarely found in HNF1α-mutated tumors [14] This case report stresses the importance of having a high suspicion for HA when seeing a patient with a history of anabolic steroid abuse and liver masses. It reiterates that it can be difficult to differentiate HA from well-differentiated HCC on imaging and/or with a limited biopsy. Dr Esnaola has served as a consultant for Merck, Celgene, and AngioDynamics
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