How is hepatocellular adenoma (HCA) treated?

Updated: Feb 21, 2018
  • Author: Bradford A Whitmer, DO; Chief Editor: BS Anand, MD  more...
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Patients should stop using oral contraceptives or anabolic steroids. This allows for regression in the size of the majority of the tumors. Complete resolution is atypical. The risk of malignant transformation remains even after the contraceptive or steroid use has been discontinued. [56]

Symptomatic tumors should be resected, regardless of size.

Pregnancy should be avoided because of the risk of tumor growth and rupture, but it is not an absolute contraindication. There are no consensus guidelines. Surgical resection may be the best option in patients with hepatocellular adenomas who desire to become pregnant. Large incidental HCAs found during pregnancy may be considered for resection during the second trimester, when the risk is lowest. Asymptomatic HCAs smaller than 5 centimeters may be managed with close monitoring. MRI seems to be preferred given the lack of radiation, but cost effectiveness remains to be studied. Ruptured hepatocellular adenomas during pregnancy should be managed with resuscitation and resection.

Yearly ultrasound imaging and an assessment of serum serum alpha-fetoprotein (AFP) levels is a consideration in all patients with hepatocellular adenomas, especially those with multiple lesions or single lesions larger than 5 cm in diameter who do not undergo surgical resection. However, there is little evidence to support this approach. [8]

Immediate abdominal imaging is required for patients with hepatocellular adenomas who present with new or worsened abdominal pain or signs of hemodynamic instability.

Emergency hepatic arteriography with embolization should be considered to control bleeding in high-risk surgical candidates.

Transarterial embolization has been used to electively reduce the tumor mass of a large HCA, but studies are limited in using it as an elective treatment for unruptured HCA. [57, 58]

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