Title : Giant hepatocellular adenoma presenting with chronic heart failure in a young woman
Abstract:
Hepatocellular adenoma (HCA) is a rare benign liver neoplasm associated with the use of oral contraceptives, which could be complicated by bleeding and malignant transformation. Common clinical manifestations of HCA includes abdominal pain, a incidental palpable liver mass, or shock in the case of rupture. Most HCAs are incidentally diagnosed without symptom. Heart failure as the initial symptom of hepatic adenoma was not reported before. Herein, we present of a young woman with a large HA who first presented with chronic heart failure and her cardiac function recovered after surgical resection of the tumor. Giant hepatocellular adenomas are usually presented with pain in the epigastrium or asymptomatic abdominal mass. The presentation in this case was unusual, because the heart failure was the chief complaint. Liver tumor usually does not cause heart failure unless metastasis to the right atrium. For this patient, it did not have the metastasis to the right atrium, but the tumor is too large to compress the inferior vena cava. As a result, the patient had insufficient blood return to the heart inducing the cardiac failure.The treatment of tumor was difficult because of the heart failure of this patient. Surgical excision is recommended for tumors larger than 5 cm for HCA. But, at the beginning, the poor cardiac function limits the implementation of surgery. After conservative treatment, the heart function improved, and the LVEF increased to 53%. Drug therapy for heart failure is very helpful for the safety of surgery. Hepatocellular adenoma is difficult to be diagnosed by images. The presence of a stellate central scar was thought to be the specific characteristic of FNH, but in our patient it could lead to the misdiagnosis. However, different from FNH, 5% of patients with hepatocellular adenoma could undergo malignant transformation. The heart failure of the patient could be an indicator of malignant transformation of tumor, which may be associated with the growth of tumor. In summary, we firstly described the heart failure could act as the initial symptom of hepatic adenoma, and surgical resection of hepatic adenoma would be helpful for the recovery of cardiac function.
Audience Take Away:
- In summary, we firstly described the heart failure could act as the initial symptom of hepatic adenoma, and surgical resection of hepatic adenoma would be helpful for the recovery of cardiac function.
- Hepatocellular adenoma is difficult to be diagnosed by images. The presence of a stellate central scar was thought to be the specific characteristic of FNH, but in our patient it could lead to the misdiagnosis.
- Heart failure as the initial symptom of hepatic adenoma was not reported before.
