eMedicine Specialties > Gastroenterology > Liver

Hepatocellular Adenoma: Treatment & Medication

Author: 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
Coauthor(s): Kenneth Ingram, PAC, Assistant Professor, Department of Medicine, Division of Gastroenterology and Hepatology, Oregon Health Sciences University
Contributor Information and Disclosures

Updated: Aug 3, 2006

Treatment

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.
  • Symptomatic hepatocellular adenomas may be considered for resection, 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.
  • 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.

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. Elective resection should be undertaken only after a reasonable period of observation if OCPs have been discontinued only recently.
  • 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.
  • A similar approach also can be considered for pedunculated lesions.

More on Hepatocellular Adenoma

Overview: Hepatocellular Adenoma
Differential Diagnoses & Workup: Hepatocellular Adenoma
Treatment & Medication: Hepatocellular Adenoma
Follow-up: Hepatocellular Adenoma
References
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References

  1. Baum JK, Bookstein JJ, Holtz F. Possible association between benign hepatomas and oral contraceptives. Lancet. Oct 27 1973;2(7835):926-9. [Medline].

  2. De Carlis L, Pirotta V, Rondinara GF. Hepatic adenoma and focal nodular hyperplasia: diagnosis and criteria for treatment. Liver Transpl Surg. Mar 1997;3(2):160-5. [Medline].

  3. Klatskin G. Hepatic tumors: possible relationship to use of oral contraceptives. Gastroenterology. Aug 1977;DA - 19770825(2):386-94. [Medline].

  4. Lee RG. Neoplasms and other masses: Benign hepatocellular tumors. In: Diagnostic Liver Pathology. St. Louis, Mo:. Mosby-Yearbook;1994:422-430.

  5. Mergo PJ, Ros PR. Benign lesions of the liver. Radiol Clin North Am. Mar 1998;36(2):319-31. [Medline].

  6. Mortele KJ, Ros PR. Benign liver neoplasms. Clin Liver Dis. Feb 2002;6(1):119-45.

  7. Reddy KR, Schiff ER. Approach to a liver mass. Semin Liver Dis. Nov 1993;13(4):423-35. [Medline].

  8. Rooks JB, Ory HW, Ishak KG. Epidemiology of hepatocellular adenoma. The role of oral contraceptive use. JAMA. Aug 17 1979;242(7):644-8. [Medline].

  9. Weimann A, Ringe B, Klempnauer J. Benign liver tumors: differential diagnosis and indications for surgery. World J Surg. Nov-Dec 1997;21(9):983-90; discussion 990-1. [Medline].

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Further Reading

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Keywords

HA, benign hepatoma, hepatic adenoma, liver cell adenoma, oral contraceptives, oral contraceptive pills, OCP, glycogen storage disease, GSD

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Contributor Information and Disclosures

Author

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.

Coauthor(s)

Kenneth Ingram, PAC, Assistant Professor, Department of Medicine, Division of Gastroenterology and Hepatology, Oregon Health Sciences University
Disclosure: Nothing to disclose.

Medical Editor

Tushar Patel, MD, Associate Professor, Department of Internal Medicine, Texas A&M College of Medicine
Tushar Patel, MD is a member of the following medical societies: American Association for the Study of Liver Diseases and American Gastroenterological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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.

CME Editor

Alex J Mechaber, MD, FACP, Assistant Dean for Medical Curriculum, Associate Professor of Medicine, Division of General Internal 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; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
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 and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

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