Resection, transplantation and local regional therapies for liver adenomas

Abstract

Hepatocellular adenoma (HCA) is a rare benign liver-cell neoplasm, occurring predominantly in young obese women using oral contraceptives. HCA is a heterogeneous disease, which includes four subtypes (including unclassified) associated with various risks of haemorrhagic complications and malignant transformation. Magnetic resonance imaging is the modality of choice for both diagnosis and subtype characterization of HCA whereas percutaneous biopsy has only limited impact on the therapeutic strategy. In men HCA should be always resected while in women surgery should only be considered for lesions ≥5 cm and after cessation of hormonal therapy. Women with single or multiple HCAs <5 cm may be followed with regular MRI imaging since the vast majority of HCA remains stable or decreases in size. Pregnancy should not be discouraged provided close sonographic surveillance is undertaken.

Keywords::

• conservative management
• haemorrhage
• hepatocellular adenoma
• liver resection
• magnetic resonance imaging
• malignant transformation
• oral contraceptives
• trans-arterial embolization

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The increased incidence of the metabolic syndrome will probably lead to maintain the incidence of hepatocellular adenomas (HCAs) in upcoming years despite the use of oral contraception with lower hormonal concentration.

• A more and more conservative approach will be considered with the better understanding of the natural history of each subtype of this heterogeneous disease.

• MRI will allow the subtype classification restricting percutaneous biopsy to exceptional cases.

• Treatment is recommended for HCA >5 cm in female and whatever the size in men. Steatotic HCA >5 cm can be observed especially if major resection is needed.

• The laparoscopic approach should be the first option when resection is indicated.

• Although the long-term results are not well documented, noninvasive treatment by radiofrequency or embolization can have a place for borderline HCA size (3–5 cm), recurrent HCA after resection and during pregnancy.

• Embolization can be the only treatment by accentuating complete HCA necrosis in some hemorrhagic HCA.

• Pregnancy and oral contraception use are no more considered as absolute contraindications especially in females of childbearing age.

• Liver transplantation should be restricted to exceptional cases of HCA.

Notes