Hepatocellular Adenoma Treatment & Management

  • Author: Sandeep Mukherjee, MB, BCh, MPH, FRCPC; Chief Editor: Julian Katz, MD   more...
 
Updated: Jun 8, 2011
 

Medical Care

  • Patients should stop using oral contraceptives or anabolic steroids.
    • This allows for regression in the size of the majority of the tumors. Complete resolution is atypical.
    • The risk of malignant transformation remains even after the contraceptive or steroid use has been discontinued.[27]
  • Symptomatic tumors should be resected, regardless of size.
  • Pregnancy should be avoided because of the risk of growth and rupture.
    • Surgical resection may be the best option in patients with hepatocellular adenomas who desire to become pregnant.
    • Resection of large incidental hepatocellular adenomas found during pregnancy may be considered for resection during the second trimester, when the risk is lowest.
    • Ruptured hepatocellular adenomas during pregnancy should be managed with resuscitation and resection.
  • Yearly ultrasound imaging and an assessment of serum AFP levels is a consideration in all patients with hepatocellular adenomas, especially those with multiple lesions or single lesions greater than 5 cm in diameter who do not undergo surgical resection. However, there is little evidence to support this approach.[8]
  • Immediate abdominal imaging is required for patients with hepatocellular adenomas who present with new or worsened abdominal pain or signs of hemodynamic instability.
  • Emergency hepatic arteriography with embolization should be considered to control bleeding in high-risk surgical candidates.
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Surgical Care

  • Due to the increased risk of spontaneous life-threatening hemorrhage and the possible malignant transformation associated with larger-size tumors or in patients with GSD, elective surgical resection is considered for all lesions greater than 5 cm in diameter.[28] Elective resection should be undertaken only after a reasonable period of observation if OCPs have been discontinued only recently. However, several authorities recommend that all adenomas should be resected regardless of size due to rare cases of malignant transformation after adenomas have decreased in size or disappeared after discontinuation of OCPs.
  • Deneve et al reported that tumors that were more likely to rupture were larger tumors and in women with recent hormone use based on an analysis of 124 patients from a multicenter study.[29] The investigators recommended surgical resection when hepatocellular adenomas approached 4 cm in size or if hormonal therapy was required.
  • All patients with significant elevated AFP levels should undergo resection of the tumor regardless of size.
  • The majority can be resected locally or with segmental partial lobectomy. Elective resection carries approximately 13% morbidity. Mortality is rare. Complication rates associated with emergency surgery are higher, including a mortality rate of approximately 5-8%.
  • Laparoscopic resection can be used in patients who have small tumors within the anterolateral liver segments and for pedunculated tumors.
  • Cho et al reported their experience with the management and outcomes of 41 patients with hepatocellular adenomas treated at the University of Pittsburgh between 1988 and 2007.[30] The investigators reported that surgical resection was preferable to observation if patients comorbidities and anatomical location are acceptable due to risks of hemorrhagic (29%) and malignancy (5%).
  • In rare patients with multiple adenomas or glycogen storage disease, liver transplantation may be the only intervention that may remove all lesions and cure the underlying metabolic defect.[11, 31] Liver transplantation has also been successfully performed for spontaneous intrapartum rupture of an hepatocellular adenoma.[32]
  • Radiofrequency (RF) ablation can be used effectively in the treatment of hepatocellular carcinoma.[33] However, multiple sessions are often required, and signs of residual adenoma might persist in some patients despite repetitive treatment. RF ablation might be especially beneficial in cases not amenable to surgery or in patients who would require major hepatic resection otherwise.
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Contributor Information and Disclosures
Author

Sandeep Mukherjee, MB, BCh, MPH, FRCPC  Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center

Sandeep Mukherjee, MB, BCh, MPH, FRCPC is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Merck Honoraria Speaking and teaching; Ikaria Pharmaceuticals Honoraria Board membership

Coauthor(s)

Kenneth Ingram, PAC  Assistant Professor, Department of Medicine, Division of Gastroenterology and Hepatology, Oregon Health and Science University School of Medicine

Disclosure: Nothing to disclose.

Brian S Berk, MD  Assistant Professor, Department of Medicine, Dartmouth Medical School; Director of End Stage Liver Disease, Section of Gastroenterology, Dartmouth Hitchcock Medical Center

Brian S Berk, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, and American Gastroenterological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Tushar Patel, MB, ChB  Professor of Medicine, Ohio State University Medical Center

Tushar Patel, MB, ChB is a member of the following medical societies: American Association for the Study of Liver Diseases and American Gastroenterological Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

James L Achord, MD  Professor Emeritus, Department of Medicine, Division of Digestive Diseases, University of Mississippi School of Medicine

James L Achord, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Mississippi State Medical Association, New York Academy of Sciences, Sigma Xi, and Southern Medical Association

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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