Brief Reports
Copyright ©The Author(s) 2005. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2005; 11(36): 5691-5695
Published online Sep 28, 2005. doi: 10.3748/wjg.v11.i36.5691
Management of hepatocellular adenoma: Solitary-uncomplicated, multiple and ruptured tumors
Christian Toso, Pietro Majno, Axel Andres, Laura Rubbia-Brandt, Thierry Berney, Léo Buhler, Philippe Morel, Gilles Mentha
Christian Toso, Pietro Majno, Axel Andres, Thierry Berney, Léo Buhler, Philippe Morel, Gilles Mentha, Abdominal and Transplant Surgery, University Hospital, Geneva, Switzerland
Laura Rubbia-Brandt, Clinical Pathology, University Hospital, Geneva, Switzerland
Author contributions: All authors contributed equally to the work.
Correspondence to: Christian Toso, Clinic of Digestive and Transplant Surgery, University Hospital, 24, rue Micheli-du-Crest, 1211 Geneva 14, Switzerland. christian.toso@hcuge.ch
Telephone: +41-22-3727702 Fax: +41-22-3727755
Received: December 10, 2004
Revised: February 13, 2005
Accepted: February 18, 2005
Published online: September 28, 2005
Abstract

AIM: While hepatocellular adenomas (HAs) have often been studied as a unique entity, we aimed to better define current management of the various forms of HAs.

METHODS: Twenty-five consecutive patients operated for solitary-uncomplicated (9), multiple (6), and ruptured (10) HAs were reviewed according to management strategies and outcomes.

RESULTS: All solitary-uncomplicated HAs (ranged 2.2-14 cm in size) were removed. Out of 25 HAs, 2 (8%) included foci of carcinoma. In the multiple HA group, previously undiagnosed tumors were identified during surgery in 5/6 cases. In three cases with multiple spread HA, several lesions had to be left unresected. They remained unmodified after 4-, 6-, and 6-year radiological follow-up. Patients with ruptured HA (ranged 1.7-10 cm in size) were initially managed with hemodynamic support and angiography, allowing the embolization of actively bleeding tumors in two patients. All ruptured tumors were subsequently removed 5.5 d (range 4-70 d) after admission.

CONCLUSION: Tumors suspected of HA, regardless of the size, should be resected, because of high chances of rupture causing bleeding, and/or containing malignant foci. Although it is desirable to remove all lesions of multiple HA, this may not be possible in some patients, for whom long-term radiological follow-up is advised. Ruptured HA can be managed by hemodynamic support and angiography, allowing scheduled surgery.

Keywords: Liver; Adenoma; Management; Surgery