Hepatocellular adenoma

Behavior and complications of hepatocellular adenoma during pregnancy and puerperium: a retrospective study and systematic review

BACKGROUND

Hepatocellular adenomas (HCA) are benign liver tumors at risk of hemorrhage. The influence of pregnancy on HCA growth and potential bleeding remains unclear. This study investigates HCA-associated behavior and bleeding complications during or shortly after pregnancy.

METHODS

(I) Single center retrospective cohort study of HCA during and after pregnancy (II) Systematic literature review.

RESULTS

The retrospective study included 11 patients, of which 4 with HCA ≥5 cm. In only two patients HCA showed growth during pregnancy. In this local cohort, no HCA-related hemorrhages occurred during median follow-up of 34 months (interquartile range 19-58 months). The systematic review yielded 33 studies, totaling 90 patients with 99 pregnancies. Of 73 pregnancies without prior HCA-related intervention, 39 HCA remained stable (53.4%), 11 regressed (15.1%), and 23 (31.5%) progressed. Fifteen HCA-related hemorrhages occurred in HCA measuring 6.5-17.0 cm. Eight patients experienced bleeding during pregnancy, two during labor and five postpartum.

CONCLUSION

Although hemorrhage of HCA during or shortly after pregnancy is rare and only reported in HCA ≥6.5 cm, it can be fatal. Pregnancy in women with HCA, regardless of size, warrant a close surveillance strategy. Observational studies on behavior and management of HCA ≥5 cm during and immediately after pregnancy are needed.

A review of liver masses in pregnancy and a proposed algorithm for their diagnosis and management

BACKGROUND

Liver masses in pregnancy are rare; some behave aggressively while others remain indolent. The paucity of case series has hindered the development of a defined approach to their diagnosis and management. This paper presents an algorithm for the diagnosis and management of hepatic hemangiomas, focal nodular hyperplasia, liver cell adenomas and hepatocellular carcinoma associated with pregnancy based on our own experience and literature review.

DATA SOURCES

A Medline search from 1966 to present was performed. Seven additional illustrative cases from our institution are included. Twenty pregnancies with hepatic hemangiomas, 37 with focal nodular hyperplasias, 26 with liver cell adenomas and 33 with hepatocellular carcinomas were identified.

CONCLUSIONS

Gestational hepatic hemangiomas and focal nodular hyperplasia behave indolently and can be observed. Liver cell adenomas often require surgery, but small, asymptomatic lesions may be carefully observed. Meticulous observation postpartum is mandatory. As pregnancy impacts survival in hepatocellular carcinoma, resection maybe indicated.