S5453 Atypical Presentation of Hepatocellular Adenoma in Young Male

Introduction: Hepatocellular adenomas (HCAs) are rare and benign tumors that are typically found in womans who are on oral contraceptives. However, the prevalence of HCAs, particularly in male patients, has markedly increased as the rates of obesity and metabolic syndrome have risen. Case Description/Methods: A 23-year-old man presented with abdominal and shoulder pain of one day duration. On exam, he was tachycardic to 120, his blood pressure was 158/106, and he had diffuse abdominal tenderness to palpation. Initial laboratory workup revealed normocytic anemia and elevated transaminases, with aspartate aminotransferase at 209 and alanine aminotransferase at 100. Computed tomography angiography (CTA) of the chest and abdomen was negative for pulmonary embolism, but revealed 3 liver masses, the largest measuring 18 cm. There was evidence of internal hemorrhage and hemoperitoneum. The patient was transfused with 2 units of packed red blood cells (pRBCs) and transferred to our hospital for evaluation of hepatobiliary surgery. The repeat CTA showed no active extravasation, and his hemoglobin remained stable. After 2 days, his hemoglobin dropped again, and interventional radiology performed an embolization of the right hepatic artery with transfusion of 2 more units of pRBCs. An MRI of the abdomen showed findings concerning for malignancy. Hepatobiliary surgery was consulted, and it was determined that resection of the dominant mass would likely leave insufficient parenchyma to sustain the patient. The liver mass was biopsied and determined to be a benign hepatic adenoma. The case was discussed at the tumor board with consideration of ligation of the right portal vein in an attempt to hypertrophy the left lobe before resection. Bariatric surgery determined that lifestyle changes were necessary before resection. On follow-up, the patient achieved significant weight loss, and his liver enzymes normalized. Discussion: HCAs are a rare tumor that are usually only considered diagnostically in women on oral contraceptives. The incidence is approximately 3-4 per 100,000 people with long-term use of OCPs, and only 0.13 per 100,000 non-users. However, the prevalence of HCAs has markedly increased as the rates of obesity and metabolic syndrome rise concurrently. Rates of men diagnosed with HCA have risen rapidly over the past several decades. This is concerning given that the risk of malignant transformation appears to be higher in males, with up to 47% of HCA eventually undergoing malignant transformation into hepatocellular carcinoma.