title: Management of hepatocellular adenoma: solitary-uncomplicated, multiple and ruptured tumors.
abstract: OBJECTIVE
  While hepatocellular adenomas (HAs) have often been studied as a unique entity, we aimed to better define current management of the various forms of HAs.
  
  
  METHODS
  Twenty-five consecutive patients operated for solitary-uncomplicated (9), multiple (6), and ruptured (10) HAs were reviewed according to management strategies and outcomes.
  
  
  RESULTS
  All solitary-uncomplicated HAs (ranged 2.2-14 cm in size) were removed. Out of 25 HAs, 2 (8%) included foci of carcinoma. In the multiple HA group, previously undiagnosed tumors were identified during surgery in 5/6 cases. In three cases with multiple spread HA, several lesions had to be left unresected. They remained unmodified after 4-, 6-, and 6-year radiological follow-up. Patients with ruptured HA (ranged 1.7-10 cm in size) were initially managed with hemodynamic support and angiography, allowing the embolization of actively bleeding tumors in two patients. All ruptured tumors were subsequently removed 5.5 d (range 4-70 d) after admission.
  
  
  CONCLUSIONS
  Tumors suspected of HA, regardless of the size, should be resected, because of high chances of rupture causing bleeding, and/or containing malignant foci. Although it is desirable to remove all lesions of multiple HA, this may not be possible in some patients, for whom long-term radiological follow-up is advised. Ruptured HA can be managed by hemodynamic support and angiography, allowing scheduled surgery.
authors.affiliation: Abdominal and Transplant Surgery, University Hospital, 24, rue Micheli-du-Crest, 1211 Geneva 14, Switzerland. christian.toso@hcuge.ch
authors.forename: Christian
authors.initials: C
authors.lastname: Toso
authors.forename: Pietro
authors.initials: P
authors.lastname: Majno
authors.forename: Axel
authors.initials: A
authors.lastname: Andres
authors.forename: Laura
authors.initials: L
authors.lastname: Rubbia-Brandt
authors.forename: Thierry
authors.initials: T
authors.lastname: Berney
authors.forename: Léo
authors.initials: L
authors.lastname: Buhler
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
authors.forename: Gilles
authors.initials: G
authors.lastname: Mentha
mesh_terms: D018248:Adenoma, Liver Cell / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D005260:Female; D006470:Hemorrhage / Q000150:complications / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012422:Rupture, Spontaneous / Q000150:complications / Q000473:pathology*; D016896:Treatment Outcome