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Authors
Abstract(s)
O adenoma hepatocelular é um tumor hepático benigno raro que afeta principalmente
mulheres em idade fértil. É, frequentemente, um achado incidental. Tipicamente
associado ao uso prolongado da contraceção hormonal combinada, tem-se verificado
cada vez mais a sua associação com outros fatores de risco, como a obesidade. As
principais complicações do adenoma hepático são a hemorragia e a transformação
maligna para carcinoma hepatocelular. O seu crescimento é sobretudo influenciado
hormonalmente. Deste modo, o período da gravidez mostra-se especialmente propenso
ao crescimento e rotura do adenoma, com potencial de complicações para a mãe e para
o feto.
É apresentado um caso clínico de rotura espontânea de adenoma hepatocelular numa
mulher grávida de 38 semanas. Esta gravidez resultou de procedimentos de procriação
medicamente assistida. Na sequência de uma ida à Urgência, no Centro Hospitalar
Universitário da Cova da Beira, por dor epigástrica intensa de surgimento súbito, que
evoluiu para um quadro de síndrome de sofrimento fetal, realizou-se cesariana
emergente. Durante a cesariana, verifica-se presença de hemoperitoneu e é detetada uma
formação nodular hepática com aproximadamente 10 cm no lobo direito do fígado. Após
a cesariana é realizada Tomografia Computadorizada Abdominal que confirma a
presença de massa hepática no lobo hepático direito. No 9º dia pós-cesariana, a doente
realizou exérese do segmento 5 do fígado e colecistectomia. A peça cirúrgica foi enviada
para estudo histológico, tendo sido diagnosticado Adenoma Hepatocelular de tipo
Inflamatório. A doente manteve vigilância com ecografia abdominal, estudo da função
hepática e medição de alfa-fetoproteína de forma semestral nos primeiros dois anos após
a resseção cirúrgica e, posteriormente, de forma anual. Durante o seguimento, não foram
encontradas alterações ou novas queixas.
Partindo deste caso clínico, fez-se uma revisão da literatura sobre o adenoma hepático e
sobre a evidência científica atual desta entidade. Destacam-se ainda as principais
complicações do tumor, especialmente no período gestacional. Apesar de ser uma
entidade rara, pelo risco hemorrágico e potencial de malignização, a sua apresentação
clínica e complicações devem ser atempadamente reconhecidas. Acresce ainda que, na
mulher grávida, pelo risco aumentado de rotura espontânea do tumor e pela
possibilidade de complicações major para o bem-estar fetal e materno, deve ser
considerado como uma hipótese diagnóstica e perante um diagnóstico prévio de adenoma hepatocelular, o seu crescimento deve ser devidamente vigiado. A gravidez não
está contraindicada em mulheres com adenomas de tamanho inferior a 5 cm.
Hepatocellular adenoma is a rare benign liver tumour, mainly affecting women 0f childbearing age. It is often an incidental finding. Typically associated with the prolonged use of combined hormonal contraception, it is increasingly being associated with other risk factors, such as obesity. The main complications of hepatic adenoma are haemorrhage and malignant transformation to hepatocellular carcinoma. Its growth is mainly hormonally influenced. Thus, pregnancy is particularly prone to adenoma growth and rupture, with potential complications for the mother and foetus. A clinical case of spontaneous rupture of hepatocellular adenoma in a 38-week pregnant woman is presented. This pregnancy resulted from medically assisted procreation procedures. Following a visit to the Emergency Department of the Centro Hospitalar Universitário da Cova da Beira, for sudden intense epigastric pain, which evolved into a foetal distress syndrome, an emergency caesarean section was performed. During the caesarean section, the presence of hemoperitoneum was noted and a nodular hepatic mass of approximately 10 cm in the right lobe of the liver was detected. After caesarean section, an abdominal computed tomography scan was performed and confirmed the presence of a hepatic mass in the right lobe of the liver. On the 9th day after caesarean section, the patient underwent excision of segment 5 of the liver and cholecystectomy. The surgical specimen was sent for histological study and was diagnosed as inflammatory hepatocellular adenoma. The patient was kept under surveillance with abdominal ultrasound, study of hepatic function and alpha fetoprotein parametrer aevery six months for the first two years after surgical resection and thereafter annually. During follow-up, no changes or new complaints were found. Based on this clinical case, a review of the literature on hepatic adenoma and on the current scientific evidence of this entity was carried out. The main complications of the tumour also stand out, especially in the gestational period. Despite being a rare entity, due to the haemorrhagic risk and potential malignancy, its clinical presentation and complications must be timely recognised. Furthermore, in pregnant women, due to the increased risk of spontaneous rupture of the tumour and the possibility of major complications for foetal and maternal well-being, it must be considered as a diagnostic hypothesis and given a previous diagnosis of hepatocellular adenoma, its growth must be properly monitored. Pregnancy is not contraindicated in women with adenomas of less than 5 cm in size.
Hepatocellular adenoma is a rare benign liver tumour, mainly affecting women 0f childbearing age. It is often an incidental finding. Typically associated with the prolonged use of combined hormonal contraception, it is increasingly being associated with other risk factors, such as obesity. The main complications of hepatic adenoma are haemorrhage and malignant transformation to hepatocellular carcinoma. Its growth is mainly hormonally influenced. Thus, pregnancy is particularly prone to adenoma growth and rupture, with potential complications for the mother and foetus. A clinical case of spontaneous rupture of hepatocellular adenoma in a 38-week pregnant woman is presented. This pregnancy resulted from medically assisted procreation procedures. Following a visit to the Emergency Department of the Centro Hospitalar Universitário da Cova da Beira, for sudden intense epigastric pain, which evolved into a foetal distress syndrome, an emergency caesarean section was performed. During the caesarean section, the presence of hemoperitoneum was noted and a nodular hepatic mass of approximately 10 cm in the right lobe of the liver was detected. After caesarean section, an abdominal computed tomography scan was performed and confirmed the presence of a hepatic mass in the right lobe of the liver. On the 9th day after caesarean section, the patient underwent excision of segment 5 of the liver and cholecystectomy. The surgical specimen was sent for histological study and was diagnosed as inflammatory hepatocellular adenoma. The patient was kept under surveillance with abdominal ultrasound, study of hepatic function and alpha fetoprotein parametrer aevery six months for the first two years after surgical resection and thereafter annually. During follow-up, no changes or new complaints were found. Based on this clinical case, a review of the literature on hepatic adenoma and on the current scientific evidence of this entity was carried out. The main complications of the tumour also stand out, especially in the gestational period. Despite being a rare entity, due to the haemorrhagic risk and potential malignancy, its clinical presentation and complications must be timely recognised. Furthermore, in pregnant women, due to the increased risk of spontaneous rupture of the tumour and the possibility of major complications for foetal and maternal well-being, it must be considered as a diagnostic hypothesis and given a previous diagnosis of hepatocellular adenoma, its growth must be properly monitored. Pregnancy is not contraindicated in women with adenomas of less than 5 cm in size.
Description
Keywords
Adenoma Hepatocelular Fígado Gestão do Doente Gravidez Hemorragia