Hepatocellular adenoma surgery

Hepatocellular adenoma Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] Zahir Ali Shaikh, MD[3]

Overview

There is no specific medical therapy for the hepatocellular adenomas. The wait and watch policy is recommended for hepatocellular adenoams <5cm following cessation of offending drugs (OCPs) and no further growth detected. Annual followup is scheduled with MRI or ultrasound until menopause.

Hepatocellular adenoma surgery

• There is no specific medical therapy for the hepatocellular adenoma.
• Historically, hepatocellular adenomas were treated with a wait and watch policy, with surgical intervention recommended for larger (>5cm) tumors.
• In asymptomatic female patients of hepatocellular adenomas , the first step is to stop the offending drug (OCPs) and check adenoma size on followup.
• The wait and watch policy is recommended when hepatocellular adenomas are <5cm or regress (to <5cm) following cessation of offending drug (OCPs) and no further growth detected.
• An yearly followup with MRI or ultrasound is scheduled for patients untill menopause.

MRI features of hepatic adenoma

Asymptomatic

Symptomatic

Male & glycogen storage disease

Female

Hemodynamically stable

Hemodynamically unstable

Resection irrespective of size & sybtype

Stop offending drugs

Radiofrequency ablation resection

Embolization resection

<5cm

>5cm

Steatotic (HNF1 a) Hepatic adenoma

Inflammatory hepatic adenoma

Beta catenin hepatic adenoma

Otehrs

Consider resection

Followup, genetic counselling for MODY & hepatic adenomatosis

Close followup, treatment of obesity & discontinue obesity

Biopsy & resection if confirmed

Biopsy & treat based on subtype

References

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