Hepatocellular adenoma: when and how to treat? Update of current evidence.
Hepatocellular adenoma (HCA) is a rare, benign liver tumor. Discovery of this tumor is usually as an incidental finding, correlated with the use of oral contraceptives, or pregnancy. Treatment options have focused on conservative management for the straightforward, smaller lesions (<5 cm), with resection preferred for larger lesions (>5 cm) that pose a greater risk of hemorrhage or malignant progression. In recent years, a new molecular subclassification of HCA has been proposed, associated with characteristic morphological features and loss or increased expression of immunohistochemical markers. This subclassification could possibly provide considerable benefits in terms of patient stratification, and the selection of treatment options. In this review we discuss the decision-making processes and associated risk analyses that should be made based on lesion size, and subtype. The usefulness of this subclassification system in terms of the procedures instigated as part of the diagnostic work-up of a suspected HCA will be outlined, and suitable treatment schemes proposed.
Department of Radiology, Erasmus Medical Center Rotterdam, P.O Box 2040, 3015 CE Rotterdam, The Netherlands.
Maarten G
MG
Thomeer
Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Mirelle
M
Broker
Department of Pathology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Joanne
J
Verheij
Department of pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Michael
M
Doukas
Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Turkan
T
Terkivatan
Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Diederick
D
Bijdevaate
Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Robert A
RA
De Man
Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Adriaan
A
Moelker
Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Jan N
JN
IJzermans
MRI; adenoma; immunohistochemistry; liver