title: Management of Hepatocellular Adenoma: Recent Advances.
abstract: Hepatocellular adenoma (HCA) is a rare benign liver cell neoplasm that occurs more frequently in young women with a history of prolonged use of oral contraceptives. Surgical resection is considered because of the risk of hemorrhage in 25% and of malignant transformation in 5% of patients with HCA. HCA is a heterogeneous disease comprising 3 subtypes with distinct molecular and complication profiles. The inflammatory or telangiectatic subtype is at increased risk for hemorrhage, the β-catenin-activated subtype is at increased risk for malignant transformation, and the hepatocyte nuclear factor-1α-inactivated or steatotic subtype is at the least risk for complications. One-third of the patients with HCA have multiple tumors on imaging with no increased risk of complications. Magnetic resonance imaging is the modality of choice for the diagnosis and subtype characterization of HCA. Systematic resection of HCA is recommended in male patients owing to the higher incidence of malignant transformation, and surgical excision in women should be reserved for tumors 5 cm or larger associated with an increased risk of complications. Cessation of hormonal therapy and radiologic surveillance in women with HCA tumors smaller than 5 cm shows that the vast majority of HCA remain stable or undergo spontaneous regression. Percutaneous core needle biopsy is of limited value because the therapeutic strategy is based primarily on patient sex and tumor size. Transarterial embolization is the initial treatment for HCA complicated by hemorrhage. Pregnancy should not be discouraged in the presence of HCA, however, frequent sonographic surveillance is recommended.
authors.affiliation: Hepatobiliary and Pancreatic Surgery, Department of Surgical Oncology, Indraprastha Apollo Hospitals, New Delhi, India.
authors.forename: Shefali
authors.initials: S
authors.lastname: Agrawal
authors.affiliation: Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Sheela
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Thomas
authors.initials: T
authors.lastname: Arnason
authors.affiliation: Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Saini
authors.affiliation: Department of Hepatobiliary and Transplant Surgery, Beaujon Hospital, University of Paris, Clichy, France. Electronic address: jacques.belghiti@bjn.aphp.fr.
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
mesh_terms: D018248:Adenoma, Liver Cell / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D019468:Disease Management; D004621:Embolization, Therapeutic / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods
keywords: Conservative Management; Hemorrhage; Hepatocellular Adenoma; Liver Resection; Malignant Transformation; Pregnancy