title: Management of hepatocellular adenoma during pregnancy.
abstract: OBJECTIVE
  Hepatocellular adenoma in pregnant women requires special considerations because of the risk of hormone induced growth and rupture. To prevent these potential lethal complications, pregnancy is either often discouraged or the surgical resection of large adenomas is recommended. It may be questioned whether it is justified to deny a young woman a pregnancy, as the biological behaviour of hepatocellular adenoma may be less threatening than presumed. In this study we establish the management of hepatocellular adenoma during pregnancy based on our own experience and literature.
  
  
  METHODS
  Twelve women with documented hepatocellular adenoma were closely monitored during a total of 17 pregnancies between 2000 and 2009. Their files were reviewed.
  
  
  RESULTS
  In four cases, hepatocellular adenomas grew during pregnancy, requiring a Caesarean section in one patient (two pregnancies) at 36 and 34 weeks because of an assumed high risk of rupture. In one case radiofrequency ablation therapy was applied in the first trimester to treat a hormone sensitive hepatocellular adenoma, thereby excluding potential growth later in pregnancy. No intervention was performed in the other 14 cases and all pregnancies had an uneventful course with a successful maternal and fetal outcome.
  
  
  CONCLUSIONS
  A "wait and see" management may be advocated in pregnant women presenting with a hepatocellular adenoma. In women with large tumours or in whom hepatocellular adenoma had complicated previous pregnancies, surgical resection may be recommended. In women with smaller adenomas it may no longer be necessary to discourage pregnancy.
authors.affiliation: Department of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Johanna E
authors.initials: JE
authors.lastname: Noels
authors.forename: Susanna M
authors.initials: SM
authors.lastname: van Aalten
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van der Windt
authors.forename: Niels F M
authors.initials: NF
authors.lastname: Kok
authors.forename: Rob A
authors.initials: RA
authors.lastname: de Man
authors.forename: Turkan
authors.initials: T
authors.lastname: Terkivatan
authors.forename: Jan N M
authors.initials: JN
authors.lastname: Ijzermans
mesh_terms: D018248:Adenoma, Liver Cell / Q000150:complications* / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D000328:Adult; D003276:Contraceptives, Oral / Q000009:adverse effects; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous / Q000517:prevention & control; D057832:Watchful Waiting; D055815:Young Adult
chemical_list: D003276:Contraceptives, Oral