The Hepatic adenomatosis and steroid-induced liver tumors – a modern clinical challenge in gynecology and sports medicine

a narrative review

Abstract

Background
Hepatocellular adenoma (HCA) is a rare benign liver tumor strongly associated with hormonal exposure, particularly estrogen-containing oral contraceptives and anabolic-androgenic steroids. Although benign, HCA is clinically significant because of the risks of hemorrhage and malignant transformation into hepatocellular carcinoma (HCC), especially in high-risk molecular subtypes.

Aim
This narrative review summarizes current evidence on the molecular classification, pathogenesis, diagnosis, and management of hepatocellular adenoma and hepatic adenomatosis.

Material and Methods
A literature review was conducted using the PubMed and Scopus databases. Studies on epidemiology, molecular mechanisms, diagnostic imaging, and therapeutic strategies were reviewed.

Results
Hormonal exposure promotes hepatocellular proliferation through dysregulated estrogen and androgen signaling. β-catenin–activated adenomas carry the highest risk of malignant transformation, while inflammatory and HNF1A-inactivated subtypes show distinct molecular and imaging features. Hepatic adenomatosis is associated with an increased risk of complications. Magnetic resonance imaging is the diagnostic modality of choice, whereas biopsy is reserved for selected cases because of hemorrhagic risk. Management includes withdrawal of hormonal triggers and, when indicated, surgical resection or embolization.

Conclusions
HCA is a molecularly heterogeneous, hormonally driven liver tumor requiring risk-adapted management. Early identification of high-risk lesions is essential to prevent hemorrhage and malignant transformation.