Hepatocellular adenoma surgery: Difference between revisions

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==Surgery==
==Surgery==
* [[Surgery]] is the treatment of choice for hepatocellular adenoma, as it can achieved in a controlled and safe manner.<ref>{{Cite journal
* [[Surgery]] is the treatment of choice for hepatocellular adenoma.<ref>{{Cite journal
  | author = [[Paulette Bioulac-Sage]], [[Herve Laumonier]], [[Gabrielle Couchy]], [[Brigitte Le Bail]], [[Antonio Sa Cunha]], [[Anne Rullier]], [[Christophe Laurent]], [[Jean-Frederic Blanc]], [[Gaelle Cubel]], [[Herve Trillaud]], [[Jessica Zucman-Rossi]], [[Charles Balabaud]] & [[Jean Saric]]
  | author = [[Paulette Bioulac-Sage]], [[Herve Laumonier]], [[Gabrielle Couchy]], [[Brigitte Le Bail]], [[Antonio Sa Cunha]], [[Anne Rullier]], [[Christophe Laurent]], [[Jean-Frederic Blanc]], [[Gaelle Cubel]], [[Herve Trillaud]], [[Jessica Zucman-Rossi]], [[Charles Balabaud]] & [[Jean Saric]]
  | title = Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience
  | title = Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience
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  | pmid = 19585623
  | pmid = 19585623
}}</ref><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>
}}</ref><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 [[Surgery|surgical]] [[resection]] of hepatocellular adenoma is considered for all [[adenoma]] [[Lesion|lesions]] >5cm in [[diameter]], [[Lesion|lesions]] that increase in size, [[Lesion|lesions]] with [[Tumoral|intratumoral]] [[hemorrhage]] and male patients (irrespective of [[adenoma]] size).<ref>{{Cite journal
* Elective [[Surgery|surgical]] [[resection]] of hepatocellular adenoma is considered for all [[adenoma]] [[Lesion|lesions]] with the following characteristics:<ref>{{Cite journal
  | author = [[T. Terkivatan]], [[J. H. de Wilt]], [[R. A. de Man]], [[R. R. van Rijn]], [[H. W. Tilanus]] & [[J. N. IJzermans]]
  | author = [[T. Terkivatan]], [[J. H. de Wilt]], [[R. A. de Man]], [[R. R. van Rijn]], [[H. W. Tilanus]] & [[J. N. IJzermans]]
  | title = Treatment of ruptured hepatocellular adenoma
  | title = Treatment of ruptured hepatocellular adenoma
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  | pmid = 8472159
  | pmid = 8472159
}}</ref>
}}</ref>
* [[Liver transplantation]] may be considered for patients of hepatocellular adenoma associated with [[Glycogen storage disease type I|glycogen storage disease type 1]].<ref>{{Cite journal
**[[Lesion|Lesions]] > 5 cm in [[diameter]]
**[[Lesion|Lesions]] that increase in size
**[[Lesion|Lesions]] with [[Tumoral|intratumoral]] [[hemorrhage]]
**Male patients (irrespective of [[adenoma]] size)
* [[Liver transplantation]] may be considered for hepatocellular adenoma associated with [[Glycogen storage disease type I|glycogen storage disease type 1]].<ref>{{Cite journal
  | author = [[Jan P. Lerut]], [[Olga Ciccarelli]], [[Christine Sempoux]], [[Etienne Danse]], [[Jacques deFlandre]], [[Yves Horsmans]], [[Etienne Sokal]] & [[Jean-Bernard Otte]]
  | author = [[Jan P. Lerut]], [[Olga Ciccarelli]], [[Christine Sempoux]], [[Etienne Danse]], [[Jacques deFlandre]], [[Yves Horsmans]], [[Etienne Sokal]] & [[Jean-Bernard Otte]]
  | title = Glycogenosis storage type I diseases and evolutive adenomatosis: an indication for liver transplantation
  | title = Glycogenosis storage type I diseases and evolutive adenomatosis: an indication for liver transplantation
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  | pmid = 12904843
  | pmid = 12904843
}}</ref>
}}</ref>
* In adenoma patients who are poor candidates for [[surgery]] (centrally located [[Lesion|lesions]], multiple [[Adenoma|adenomas]], [[morbid obesity]]), [[Radiofrequency ablation|radiofrequency ablation (RFA)]] and transcatheter [[Artery|arterial]] [[embolization]] (TAE) may be considered.
* In adenoma [[Patient|patients]] who are poor candidates for [[surgery]] (centrally located [[Lesion|lesions]], multiple [[Adenoma|adenomas]], and [[morbid obesity]]), [[Radiofrequency ablation|radiofrequency ablation (RFA)]] and transcatheter [[Artery|arterial]] [[embolization]] (TAE) may be considered.
* [[Radiofrequency ablation|Radiofrequency ablation (RFA)]] is a minimally [[Invasive (medical)|invasive]] technique that can be used for hepatocellular adenomas, [[hepatocellular carcinoma]] and [[colorectal]] [[Metastasis|metastases]] as well.<ref>{{Cite journal
* [[Radiofrequency ablation|Radiofrequency ablation (RFA)]] is a [[Minimally invasive procedure|minimally invasive technique]] that can be used for hepatocellular adenoma, [[hepatocellular carcinoma]], and [[colorectal]] [[Metastasis|metastases]] as well.<ref>{{Cite journal
  | author = [[Maarten G. Thomeer]], [[Mirelle Broker]], [[Joanne Verheij]], [[Michael Doukas]], [[Turkan Terkivatan]], [[Diederick Bijdevaate]], [[Robert A. De Man]], [[Adriaan Moelker]] & [[Jan N. IJzermans]]
  | author = [[Maarten G. Thomeer]], [[Mirelle Broker]], [[Joanne Verheij]], [[Michael Doukas]], [[Turkan Terkivatan]], [[Diederick Bijdevaate]], [[Robert A. De Man]], [[Adriaan Moelker]] & [[Jan N. IJzermans]]
  | title = Hepatocellular adenoma: when and how to treat? Update of current evidence
  | title = Hepatocellular adenoma: when and how to treat? Update of current evidence
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  | pmid = 27803743
  | pmid = 27803743
}}</ref>
}}</ref>
* [[Transcatheter arterial chemoembolization|Transcatheter arterial embolization]] ([[Transcatheter arterial chemoembolization|TAE]]) is used in [[adenoma]] patients with [[hemodynamic instability]] due to [[bleeding]] hypervascular [[Artery|arterial]] lesions.
* [[Transcatheter arterial chemoembolization|Transcatheter arterial embolization]] ([[Transcatheter arterial chemoembolization|TAE]]) is used in [[adenoma]] [[Patient|patients]] with [[hemodynamic instability]] due to [[bleeding]] hyper-[[vascular]] [[Artery|arterial]] lesions.




 
* The algorithm approach to management of [[hepatocellular adenoma]] based on clinical features, gender, imaging and [[histology]].
==== Approach to the Management of Hepatocellular Adenoma Based on Clinical Features, Gender, Imaging Features, and [[Histology]]: ====
{{familytree/start}}
{{familytree/start}}
{{familytree | | | | | | | | | | | | | A01 | | | | | | | | | | | | | |A01=MRI features of hepatic adenoma }}
{{familytree | | | | | | | | | | | | | A01 | | | | | | | | | | | | | |A01=MRI features of hepatic adenoma }}

Revision as of 02:16, 23 August 2019

Hepatocellular adenoma Microchapters

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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

Surgical resection is the treatment of choice for hepatocellular adenoma larger than 5 cm in diameter, the ones that increase in size, lesions with intra-tumoral hemorrhage, and male patients (irrespective of the adenoma size). Liver transplantation may be considered for hepatocellular adenomas associated with glycogen storage disease type 1. Radiofrequency ablation (RFA) and transcatheter arterial embolization (TAE) may be considered for patients who are poor candidates for surgery.

Surgery


Approach to the Management of Hepatocellular Adenoma Based on Clinical Features, Gender, Imaging Features, 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

  1. ↑ Paulette Bioulac-Sage, Herve Laumonier, Gabrielle Couchy, Brigitte Le Bail, Antonio Sa Cunha, Anne Rullier, Christophe Laurent, Jean-Frederic Blanc, Gaelle Cubel, Herve Trillaud, Jessica Zucman-Rossi, Charles Balabaud & Jean Saric (2009). "Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience". Hepatology (Baltimore, Md.). 50 (2): 481–489. doi:10.1002/hep.22995. PMID 19585623. Unknown parameter |month= ignored (help)
  2. ↑ 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
  3. ↑ Ault GT, Wren SM, Ralls PW, Reynolds TB, Stain SC (1996). "Selective management of hepatic adenomas". Am Surg. 62 (10): 825–9. PMID 8813164.
  4. ↑ T. Terkivatan, J. H. de Wilt, R. A. de Man, R. R. van Rijn, H. W. Tilanus & J. N. IJzermans (2001). "Treatment of ruptured hepatocellular adenoma". The British journal of surgery. 88 (2): 207–209. doi:10.1046/j.1365-2168.2001.01648.x. PMID 11167868. Unknown parameter |month= ignored (help)
  5. ↑ J. Belghiti, D. Pateron, Y. Panis, V. Vilgrain, J. F. Flejou, J. P. Benhamou & F. Fekete (1993). "Resection of presumed benign liver tumours". The British journal of surgery. 80 (3): 380–383. PMID 8472159. Unknown parameter |month= ignored (help)
  6. ↑ Jan P. Lerut, Olga Ciccarelli, Christine Sempoux, Etienne Danse, Jacques deFlandre, Yves Horsmans, Etienne Sokal & Jean-Bernard Otte (2003). "Glycogenosis storage type I diseases and evolutive adenomatosis: an indication for liver transplantation". Transplant international : official journal of the European Society for Organ Transplantation. 16 (12): 879–884. doi:10.1007/s00147-003-0613-3. PMID 12904843. Unknown parameter |month= ignored (help)
  7. ↑ Maarten G. Thomeer, Mirelle Broker, Joanne Verheij, Michael Doukas, Turkan Terkivatan, Diederick Bijdevaate, Robert A. De Man, Adriaan Moelker & Jan N. IJzermans (2016). "Hepatocellular adenoma: when and how to treat? Update of current evidence". Therapeutic advances in gastroenterology. 9 (6): 898–912. doi:10.1177/1756283X16663882. PMID 27803743. Unknown parameter |month= ignored (help)


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