Management of hepatocellular adenoma: Solitary-uncomplicated, multiple and ruptured tumors

Table 1 Clinical presentation of different forms of HA

	Solitary-uncomplicated HA	Multiple HA	Ruptured HA	Total
Cases (n)	9	6	10	25
No. of HA1	9	>392	10	>58
Symptoms (no. of cases)
None	3	3	0	6
Pain	6	3	10	19
Nausea/vomiting	3	0	5	8
Diarrhea	0	0	2	2
Asthenia	1	1	0	2
Median duration of symptoms (wk)3	8 (1-24)	5 (2-16)	1 (0.5-2)	2
Signs (no. of cases)
None	6	5	0	11
Tenderness	3	1	10	14
Fever	2	0	4	6
Hepatomegaly	0	1	0	1

¹Hepatocellular adenoma;

²two patients presented more than 10 HA (adenomatosis);

³median duration of symptoms up to diagnosis, excluding asymptomatic patients (three solitary-uncomplicated and three multiple HA).

Table 2 Results of laboratory tests

Laboratorytest(range)	Solitary-uncomplicatedHA (9 cases)	MultipleHA (6 cases)	RupturedHA (10 cases)
Anemia (Hb<12 g/dL)	4	2	7
Bilirubin (>25 μmol/L)	0	0	1
ALP (>125 μmol/L)	4	4	1
AST (>42 U/L)	0	0	4
ALT (>42 U/L)	0	0	4
γ-GT (>35 U/L)	5	3	4

ALP: alkaline phosphatase; AST: aspartate aminotransferase; AST: alanine aminotransferase; γ-GT: γ-glutamyl transpeptidase.

Table 3 Surgical management of different forms of HA

	Solitary-uncomplicated HA	Multiple HA	Ruptured HA	Total
Types of operation
Enucleation	3	21,2,3		5
Segmental resection	1	12	2	4
Left hemihepatectomy	1		3	4
Hemihepatectomy (R)	4	4	4	12
Extended hemihepatectomy (R)			1	1
Median tumor size (cm, range)	6 (2.2-14)	3.05 (1.1-4)	7 (1.7-10)	5.25
Vascular exclusion (number of cases)	3	5	1	8
Median per-operative transfusions (n, range)	0 (0-2)	0 (0-4)	3 (1.7-10)	1.5
Median time between admission and operation (d, range)	3	3	5.5 (4-70)
Median duration of post-operative hospital stay (d, range)	8 (6-15)	13 (7-20)	9 (8-28)	9
Complications
Pleural effusion/atelectasis/pneumonia	1	2		3
Biliary leak		1	1	2
Pulmonary embolism			1	1
Coma	1			1

¹Seven enucleations performed in the same patient; ²performed in the same patient; ³performed in an elective setting.