A review of liver masses in pregnancy and a proposed algorithm for their diagnosis and management.
BACKGROUND
Liver masses in pregnancy are rare; some behave aggressively while others remain indolent. The paucity of case series has hindered the development of a defined approach to their diagnosis and management. This paper presents an algorithm for the diagnosis and management of hepatic hemangiomas, focal nodular hyperplasia, liver cell adenomas and hepatocellular carcinoma associated with pregnancy based on our own experience and literature review.


METHODS
A Medline search from 1966 to present was performed. Seven additional illustrative cases from our institution are included. Twenty pregnancies with hepatic hemangiomas, 37 with focal nodular hyperplasias, 26 with liver cell adenomas and 33 with hepatocellular carcinomas were identified.


CONCLUSIONS
Gestational hepatic hemangiomas and focal nodular hyperplasia behave indolently and can be observed. Liver cell adenomas often require surgery, but small, asymptomatic lesions may be carefully observed. Meticulous observation postpartum is mandatory. As pregnancy impacts survival in hepatocellular carcinoma, resection maybe indicated.
Cobey
Frederick C
FC
Department of Surgery, Section of Surgical Oncology, Yale University School of Medicine, TMP 202, 333 Cedar St., New Haven, CT 06520, USA.
Salem
Ronald R
RR
D018248:Adenoma, Liver Cell / Q000175:diagnosis / Q000628:therapy*; D000328:Adult; D000465:Algorithms; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000175:diagnosis / Q000628:therapy*; D006391:Hemangioma / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000628:therapy*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis / Q000628:therapy*