Hepatocellular adenoma surgery: Difference between revisions
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==Hepatocellular adenoma surgery== | ==Hepatocellular adenoma surgery== | ||
* | * Surgery is the treatment of choice for hepatocellular adenoma, as it can achieved in a controlled and safe manner.<ref name=cde>{{cite journal | author = Toso C, Majno P, Andres A, Rubbia-Brandt L, Berney T, Buhler L, Morel P, Mentha G | title = Management of hepatocellular adenoma: solitary-uncomplicated, multiple and ruptured tumors. | journal = World J Gastroenterol | volume = 11 | issue = 36 | pages = 5691-5 | year = 2005 | id = PMID 16237767}}''[http://www.wjgnet.com/1007-9327/11/5691.asp Full text]''</ref><ref name="pmid8813164">{{cite journal| author=Ault GT, Wren SM, Ralls PW, Reynolds TB, Stain SC| title=Selective management of hepatic adenomas. | journal=Am Surg | year= 1996 | volume= 62 | issue= 10 | pages= 825-9 | pmid=8813164 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8813164 }} </ref> | ||
* | * Elective surgical resection of hepatocellular adenoma is considered for; all adenoma lesions >5cm in diameter, lesions that increase in size, lesions with intratumoral hemorrhage and male patients (irrespective of adenoma size). | ||
* | * The liver transplantation may be considered for patients of hepatocellular adenoma associated with glycogen storage disease type1. | ||
* The | * The adenoma patients who are poor candidates for surgery (centrally located lesions, multiple adenomas, morbid obesity), radiofrequency ablation (RFA) and transcatheter arterial embolization (TAE) may be considered. | ||
* | * Radiofrequency ablation (RFA) is a minimally invasive technique that can be used for hepaocellular adenomas, hepatocellular carcinoma and colorectal metastases as well. | ||
* Transcatheter arterial embolization (TAE) is used in adenoma patients with hemodynamic instability due to bleeding hypervascular arterial lesions. | |||
* The algorithm approach to management of hepatocellular adenoma based on clinical features, gender, imaging and histology. | |||
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{{familytree | | | | | | | | | | | | | A01 | | | | | | | | | | | | | |A01=MRI features of hepatic adenoma }} | {{familytree | | | | | | | | | | | | | A01 | | | | | | | | | | | | | |A01=MRI features of hepatic adenoma }} | ||
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{{familytree | | G01 | | G02 | | G03 | | G04 | | | | | | | | | | | | | | | | |G01=Followup, genetic counselling for MODY & hepatic adenomatosis|G02=Close followup, treatment of obesity & discontinue obesity|G03=Biopsy & resection if confirmed|G04=Biopsy & treat based on subtype }} | {{familytree | | G01 | | G02 | | G03 | | G04 | | | | | | | | | | | | | | | | |G01=Followup, genetic counselling for MODY & hepatic adenomatosis|G02=Close followup, treatment of obesity & discontinue obesity|G03=Biopsy & resection if confirmed|G04=Biopsy & treat based on subtype }} | ||
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }} | {{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }} | ||
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Revision as of 16:05, 11 January 2019
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Hepatocellular adenoma Microchapters |
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Hepatocellular adenoma surgery On the Web |
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Risk calculators and risk factors for Hepatocellular adenoma surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] Zahir Ali Shaikh, MD[3]
Overview
There is no specific medical therapy for the hepatocellular adenomas. The wait and watch policy is recommended for hepatocellular adenoams <5cm following cessation of offending drugs (OCPs) and no further growth detected. Annual followup is scheduled with MRI or ultrasound until menopause.
Hepatocellular adenoma surgery
- Surgery is the treatment of choice for hepatocellular adenoma, as it can achieved in a controlled and safe manner.[1][2]
- Elective surgical resection of hepatocellular adenoma is considered for; all adenoma lesions >5cm in diameter, lesions that increase in size, lesions with intratumoral hemorrhage and male patients (irrespective of adenoma size).
- The liver transplantation may be considered for patients of hepatocellular adenoma associated with glycogen storage disease type1.
- The adenoma patients who are poor candidates for surgery (centrally located lesions, multiple adenomas, morbid obesity), radiofrequency ablation (RFA) and transcatheter arterial embolization (TAE) may be considered.
- Radiofrequency ablation (RFA) is a minimally invasive technique that can be used for hepaocellular adenomas, hepatocellular carcinoma and colorectal metastases as well.
- Transcatheter arterial embolization (TAE) is used in adenoma patients with hemodynamic instability due to bleeding hypervascular arterial lesions.
- The algorithm approach to management of hepatocellular adenoma based on clinical features, gender, imaging and histology.
| MRI features of hepatic adenoma | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Asymptomatic | Symptomatic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Male & glycogen storage disease | Female | Hemodynamically stable | Hemodynamically unstable | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Resection irrespective of size & sybtype | Stop offending drugs | Radiofrequency ablation resection | Embolization resection | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| <5cm | >5cm | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Steatotic (HNF1 a) Hepatic adenoma | Inflammatory hepatic adenoma | Beta catenin hepatic adenoma | Otehrs | Consider resection | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Followup, genetic counselling for MODY & hepatic adenomatosis | Close followup, treatment of obesity & discontinue obesity | Biopsy & resection if confirmed | Biopsy & treat based on subtype | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ Toso C, Majno P, Andres A, Rubbia-Brandt L, Berney T, Buhler L, Morel P, Mentha G (2005). "Management of hepatocellular adenoma: solitary-uncomplicated, multiple and ruptured tumors". World J Gastroenterol. 11 (36): 5691–5. PMID 16237767.Full text
- ↑ Ault GT, Wren SM, Ralls PW, Reynolds TB, Stain SC (1996). "Selective management of hepatic adenomas". Am Surg. 62 (10): 825–9. PMID 8813164.