Hepatocellular Adenoma (Hepatic Adenoma) Guidelines

Updated: Dec 03, 2020
  • Author: Michael H Piper, MD; Chief Editor: BS Anand, MD  more...
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Guidelines Summary

The American College of Gastroenterology (ACG) issued clinical guidelines for the diagnosis and management of focal liver lesions in 2014. [1] The European Association for the Study of the Liver (EASL) released clinical practice guidelines on the management of benign liver tumors in 2016. [20]  Their recommendations include the following:

  • Imaging of hepatocellular adenoma (HCA) (hepatic adenoma) with magnetic resonance imaging (MRI) is superior to all other imaging modalities and offers subtype differentiation in many cases, especially with the hepatocyte nuclear factor (HNF) 1a-mutated HCA (H-HCA) and inflammatory HCA (I-HCA) subtypes. β-catenin activated HCA (β-HCA) subtype is not well identified by any imaging technique and should be carefully looked for given its association with hepatocellular carcinoma (HCC). [20]

  • Once HCA is diagnosed, lifestyle changes including discontinuation of oral contraceptive pills (OCPs) and weight loss should be advised. [1, 20] Further management is guided by sex, size, pattern of progression, and subtype. [20] The routine use of biopsy is not recommended but may be considered in cases with inconclusive imaging or when biopsy findings may change management decisions. [1]

  • HCA resection is recommended in men and in patients with proven β-catenin mutation subtype, regardless of size. [20]

  • For women with HCA, initial lifestyle changes and 6 months of observation if no high-risk features are present is advised. Resection may be considered for HCAs of at least 5 cm or those that continue to grow. HCAs smaller than 5 cm should be followed with imaging, initially at 1 year from diagnosis and then annually thereafter. [20]  The ACG guidelines recommend considering follow-up imaging every 6-12 months, with subsequent intervals based on the stability of the lesion. [1] Pregnancy is not absolutely contraindicated for HCAs smaller than 5 cm; however, an individual approach is recommended. [1]

  • Patients with multiple HCAs should have their management based on the size of the largest tumor, and hepatic resection can be considered for the largest adenomas. Hepatic resection may also be considered in patients with unilobular disease or widespread HCA. Liver transplantation is not recommended for patients with multiple HCAs; however, it may be considered if underlying liver disease exists. Patients with bleeding HCAs and hemodynamic instability should undergo  tumor embolization; if residual lesion is found on imaging, resection may be required. [20]