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Çakır Ç. Non-traumatic spontaneous ruptured hepatocellular adenoma after selective transcatheter arterial chemo-embolization for reduction of tumor mass: A case report. ULUS TRAVMA ACIL CER 2022; 28:225-228. [PMID: 35099039 PMCID: PMC10443143 DOI: 10.14744/tjtes.2020.94838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/25/2020] [Indexed: 11/20/2022]
Abstract
It is important to detect hepatic adenomas, which are generally well-confined lesions, as urgent treatment is required due to the risk of bleeding and conversion to malignancy. Dimensions can vary between 1 and 15 cm, and the risk of hemorrhage is higher in large and multiple-focus adenomas. The case is here presented of a patient with spontaneous ruptured liver adenoma after selective transcatheter arterial chemo-embolization for reduction of tumor mass, with discussion of the clinical, computed tomography, angiographic findings, and treatment strategies.
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Affiliation(s)
- Çağlayan Çakır
- Department of Radiology, Healts Sciences University, Bakirkoy Dr. Sadi Konuk Training and Resarch Hospital, İstanbul-Turkey
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2
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van Rosmalen BV, Coelen RJS, Bieze M, van Delden OM, Verheij J, Dejong CHC, van Gulik TM. Systematic review of transarterial embolization for hepatocellular adenomas. Br J Surg 2017; 104:823-835. [DOI: 10.1002/bjs.10547] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/02/2016] [Accepted: 02/22/2017] [Indexed: 02/06/2023]
Abstract
Abstract
Background
Hepatocellular adenoma (HCA) larger than 5 cm in diameter is considered an indication for elective surgery, because of the risk of haemorrhage and malignant transformation. Transarterial embolization (TAE) is used to manage bleeding HCA and occasionally to reduce tumour size. TAE might have potential as an elective therapy, but its current role in this context is uncertain. This systematic review provides an overview of clinical outcomes after TAE, in bleeding and non-bleeding HCA.
Methods
Two independent reviewers performed a systematic search of literature in PubMed and Embase. Outcomes were change in tumour size, avoidance of surgery, complications and malignant transformation after TAE in bleeding and non-bleeding HCA. The Critical Appraisal Skills Programme tool for cohort studies was used for quality assessment of included studies.
Results
From 320 potential articles, 20 cohort studies and 20 case reports including 851 patients met the inclusion criteria. TAE was performed in 151 of 851 patients (17·7 per cent), involving 196 tumours, of which 95 (48·5 per cent) were non-bleeding. Surgical treatment was avoided in 68 of 151 patients (45·0 per cent). Elective TAE was performed in 49 patients involving 66 HCAs, with 41 of these patients (84 per cent) not requiring surgery. Major complications occurred in eight of 151 patients (5·3 per cent); no death was reported. Among cohort studies, complete tumour disappearance was observed in 10 per cent of patients, and regression in 75 per cent.
Conclusion
Acute or elective TAE in the management of HCA is safe. In the elective setting, TAE provides a potential alternative to surgery.
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Affiliation(s)
- B V van Rosmalen
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - R J S Coelen
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - M Bieze
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - O M van Delden
- Department of Interventional Radiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - J Verheij
- Department of Pathology, Academic Medical Centre, Amsterdam, The Netherlands
| | - C H C Dejong
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - T M van Gulik
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
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Pinto LEV, Silva JPR, Rêgo GC, Garcia JHP. LATE SURGICAL TREATMENT FOR SPONTANEOUS RUPTURE OF HEPATOCELLULAR ADENOMA: CASE REPORT. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2016; 28:297-9. [PMID: 26734808 PMCID: PMC4755190 DOI: 10.1590/s0102-6720201500030022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 03/26/2015] [Indexed: 11/23/2022]
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Katabathina VS, Menias CO, Shanbhogue AKP, Jagirdar J, Paspulati RM, Prasad SR. Genetics and imaging of hepatocellular adenomas: 2011 update. Radiographics 2012; 31:1529-43. [PMID: 21997980 DOI: 10.1148/rg.316115527] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Hepatocellular adenomas are benign liver neoplasms with specific but varied histopathologic findings and tumor biology. The results from recent studies of the pathologic and genetic basis of hepatocellular adenomas provide important insights into the pathogenesis and molecular changes, as well as the putative oncologic pathways used by diverse adenoma subtypes. On the basis of the genetic and pathologic features, hepatocellular adenomas are categorized into three distinct subtypes: (a) inflammatory hepatocellular adenomas, (b) hepatocyte nuclear factor 1 α-mutated hepatocellular adenomas, and (c) β-catenin-mutated hepatocellular adenomas. Different subtypes show variable clinical behavior, imaging findings, and natural history, and thus the options for treatment and surveillance may vary. Cross-sectional imaging plays an important role in the diagnosis, subtype characterization, identification of complications, and surveillance of hepatocellular adenomas. New schemas for genotype-phenotype classification of hepatic adenomas, as well as management triage of patients with specific subtypes of adenomas, are being proposed in an attempt to improve clinical outcomes.
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Affiliation(s)
- Venkata S Katabathina
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex, USA
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van Aalten SM, Witjes CDM, de Man RA, Ijzermans JNM, Terkivatan T. Can a decision-making model be justified in the management of hepatocellular adenoma? Liver Int 2012; 32:28-37. [PMID: 22098685 DOI: 10.1111/j.1478-3231.2011.02667.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 09/14/2011] [Indexed: 12/15/2022]
Abstract
During recent years, there was a great development in the area of hepatocellular adenomas (HCA), especially regarding the pathological subtype classification, radiological imaging and management during pregnancy. This review discusses the current knowledge about diagnosis and treatment modalities of HCA and proposes a decision-making model for HCA. A Medline search of studies relevant to epidemiology, histopathology, complications, imaging and management of HCA lesions was undertaken. References from identified articles were hand-searched for further relevant articles.
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Management of hepatocellular adenoma during pregnancy. J Hepatol 2011; 54:553-8. [PMID: 21094555 DOI: 10.1016/j.jhep.2010.07.022] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 06/24/2010] [Accepted: 07/07/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Hepatocellular adenoma in pregnant women requires special considerations because of the risk of hormone induced growth and rupture. To prevent these potential lethal complications, pregnancy is either often discouraged or the surgical resection of large adenomas is recommended. It may be questioned whether it is justified to deny a young woman a pregnancy, as the biological behaviour of hepatocellular adenoma may be less threatening than presumed. In this study we establish the management of hepatocellular adenoma during pregnancy based on our own experience and literature. METHODS Twelve women with documented hepatocellular adenoma were closely monitored during a total of 17 pregnancies between 2000 and 2009. Their files were reviewed. RESULTS In four cases, hepatocellular adenomas grew during pregnancy, requiring a Caesarean section in one patient (two pregnancies) at 36 and 34 weeks because of an assumed high risk of rupture. In one case radiofrequency ablation therapy was applied in the first trimester to treat a hormone sensitive hepatocellular adenoma, thereby excluding potential growth later in pregnancy. No intervention was performed in the other 14 cases and all pregnancies had an uneventful course with a successful maternal and fetal outcome. CONCLUSIONS A "wait and see" management may be advocated in pregnant women presenting with a hepatocellular adenoma. In women with large tumours or in whom hepatocellular adenoma had complicated previous pregnancies, surgical resection may be recommended. In women with smaller adenomas it may no longer be necessary to discourage pregnancy.
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Ribeiro Junior MAF, Chaib E, Saad WA, D'Albuquerque LAC, Cecconello I. Surgical management of spontaneous ruptured hepatocellular adenoma. Clinics (Sao Paulo) 2009; 64:775-9. [PMID: 19690662 PMCID: PMC2728191 DOI: 10.1590/s1807-59322009000800011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 05/20/2009] [Indexed: 02/08/2023] Open
Abstract
AIMS Spontaneous ruptured hepatocellular adenoma (SRHA) is a rare life-threatening condition that may require surgical treatment to control hemorrhaging and also stabilize the patient. We report a series of emergency surgeries performed at our institution for this condition. METHODS We reviewed medical records and radiology files of 28 patients (from 1989 to 2006) with a proven diagnosis of hepatocellular adenoma (HA). Three (10.7%) of 28 patients had spontaneous ruptured hepatocellular adenoma, two of which were associated with intrahepatic hemorrhage while one had intraperitoneal bleeding. Two patients were female and one was male. Both female patients had a background history of oral contraceptive use. Sudden abdominal pain associated with hemodynamic instability occurred in all patients who suffered from spontaneous ruptured hepatocellular adenoma. The mean age was 41.6 years old. The preoperative assessment included liver function tests, ultrasonography and computed tomography. RESULTS The surgical approaches were as follows: right hemihepatectomy for controlling intraperitoneal bleeding, and right extended hepatectomy and non-anatomic resection of the liver for intrahepatic hemorrhage. There were no deaths, and the postoperative complications were bile leakage and wound infection (re-operation), as well as intraperitoneal abscess (re-operation) and pleural effusion. CONCLUSION Spontaneous ruptured hepatocellular adenoma may be treated by surgery for controlling hemorrhages and stabilizing the patient, and the decision to operate depends upon both the patient's condition and the expertise of the surgical team.
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Affiliation(s)
- Marcelo Augusto Fontenelle Ribeiro Junior
- Department of Gastroeneterology, Liver and Portal Hypertension Unit, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil.
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Erdogan D, van Delden OM, Busch ORC, Gouma DJ, van Gulik TM. Selective transcatheter arterial embolization for treatment of bleeding complications or reduction of tumor mass of hepatocellular adenomas. Cardiovasc Intervent Radiol 2008; 30:1252-8. [PMID: 17605070 DOI: 10.1007/s00270-007-9108-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Hepatocellular adenomas (HCAs) are benign liver lesions which may be complicated by spontaneous intratumoral bleeding, with or without rupture into the abdominal cavity, or malignant degeneration. Recent advances in radiological interventional techniques now offer selective transcatheter arterial embolization (TAE) as an alternative approach to surgery as the initial treatment to stop the bleeding or as an elective treatment to reduce the tumor mass of the HCA. Herein, we report our initial experience using TAE in the management of HCA. Five female patients and one male patient presented with spontaneous hemorrhage of HCA. Four patients were initially treated with selective TAE to stop the bleeding. In two patients in whom the bleeding stopped spontaneously, TAE was electively undertaken 1 year after presentation to reduce the tumor mass of HCAs >5 cm. Selective TAE as initial treatment in patients with spontaneous bleeding of HCA with or without rupture is effective and will change the need for urgent laparotomy to control bleeding. Selective TAE may also be used as an elective treatment to reduce the tumor mass of larger HCAs.
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Affiliation(s)
- Deha Erdogan
- Department of Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 Amsterdam, AZ, The Netherlands
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Stoot JHMB, van der Linden E, Terpstra OT, Schaapherder AFM. Life-saving therapy for haemorrhaging liver adenomas using selective arterial embolization. Br J Surg 2007; 94:1249-53. [PMID: 17696216 DOI: 10.1002/bjs.5779] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Emergency treatment for patients with a ruptured hepatocellular adenoma is controversial. The aim of this study was to evaluate management with selective arterial embolization. METHODS The study included 11 consecutive patients treated for ruptured hepatocellular adenomas between 2001 and 2006. After initial haemodynamic support, all patients received selective embolization of branches of the hepatic artery. The primary outcome was effectiveness in stopping the bleeding. Secondary outcomes were complications and changes in tumour size after embolization. RESULTS A single embolization brought haemorrhaging under control in ten patients; one patient needed three embolizations. None of the patients required emergency surgery. In the follow-up of 19 (range 7-49) months, no general or hepatobiliary complications were observed. All 25 adenomas, including those without signs of haemorrhaging in the same liver lobe, were either smaller or not detectable on computed tomography or magnetic resonance imaging after embolization, with the median diameter decreasing from 7.0 to 2.5 cm (P < 0.001). CONCLUSION Selective embolization of the hepatic artery is a safe and adequate first approach in the management of patients with haemorrhaging hepatocellular adenomas. Furthermore, arterial embolization reduces the size of adenomas in the liver.
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Affiliation(s)
- J H M B Stoot
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
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