Management and outcome of hepatocellular adenoma with massive bleeding at presentation

Table 1 Clinical features at presentation

Case no.	Age (yr)	OC use	Type of bleeding, grade	Initial management	ICU	Blood products	Hospital stay (d)	Short-term complications
Initially conservatively treated
1	49	Yes	II	Cons.	No	No	19	-
2	43	Yes	III	Cons.	Yes	Yes	7	-
3	30	Yes	II	Cons.	No	No	7	-
4	36	No	II	Cons.	No	No	19	-
		Stopped 12 mo prior to bleeding
5	33	Yes	II	Cons.	No	No	8	-
6	23	Yes	II	Cons.	Yes	Yes	28	-
7	30	Yes	II	Cons.	No	No	12	-
8	39	Yes	II	Cons.	No	No	9	-
9	43	Yes	III	Cons.	No	Yes	14	-
10	44	Yes	II	Cons.	No	No	13	-
11	49	Yes	III	Cons.	Yes	Yes	61	Hypovolemic shock, respiratory insufficiency, kidney failure, abdominal compartment syndrome
12	31	Yes	II	Cons.	No	No	10	-
13	33	Yes	III	Cons.	No	No	13	-
Initially treated with intervention
14	22	Unknown	III	SAE + resection	No	Yes	40	Postoperative abdominal abscess, drainage pleural effusion
15	33	No	III	SAE	Yes	Yes	Unknown	-
		Stopped 18 mo prior to bleeding
16	24	Yes	III	SAE	Yes	Yes	18	-
17	36	Yes	II	SAE	Yes	No	22	Acute liver failure after SAE left and right hepatic artery
18	48	Yes	II	SAE	No	No	10	-
19	48	Yes	III	SAE	Yes	No	6	-
20	34	No	Unknown	SAE	Unknown	Unknown	Unknown	-
		Stopped 7 mo prior to bleeding
21	30	Yes	II	US-guided drainage	No	No	10	-
22	56	Yes	II	SAE	Yes	No	Unknown	-
23	20	Yes	III	SAE	No	Yes	33	Rebleed after 3 mo, drainage hepatic abscess, drainage pleural effusion

ICU: Intensive care unit; OC: Oral contraceptive; SAE: Selective arterial embolization; US: Ultrasound.

Table 2 Demographics and features of patients treated conservatively or with intervention

	Initial conservative, n = 13	Initial intervention, n = 10	Total, n = 23	P value
Median age (yr)	36 (30.5-43.5)	33.5 (23.5-48.0)	34 (30-44)	0.563
Median HCA diameter at diagnosis (mm)	76 (55-101.5)	76.5 (51.3-92.5)	76 (55-92)	0.648
Median follow-up time (mo)	66 (23-87)	22.5 (12.8-60.3)	36 (15-79)	0.257
Type of bleeding				0.349
Grade II	9	5	15
Grade III	4	5	8
Median hospital stay (d)	13 (8.5-19)	18 (10-33)	13 (9.3-21.3)	0.588
Median Hb level at presentation (mmol/L)	8.0 (6.0-8.4)	7.5 (7.0-8.0)	7.6 (7.0-8.1)	0.710
Median decrease Hb day 0-3 (mmol/L)	0.9 (0-1.7)	2.4 (1.6-3.5)	1.6 (0.4-2.4)	0.0061

¹Statistically significant. Values are given as median (IQR).

Table 3 Tumor features and follow-up

Case no.	Diameter HCA at diagnosis (mm)	Location of HCA	Elective treatment of HCA	Last known HCA diameter (mm)
Initially conservatively treated
1	200	Right lateral (sVI/VII)	Surveillance	6
2	76	Right lateral (sVI/VII)	Surveillance	22
3	60	Right lateral (sVI)	Surveillance	26
4	80	Right medial (sVIII)	Surveillance	53
5	80	Right lateral (sVI)	Resection	-
6	75	Right lateral (sVI/VII)	RFA	0
7	75	Right lateral (sVI/VII)	Surveillance	8
8	143	Right medial (sVIII)	Surveillance	35
9	45	Right medial (sV/VIII)	Surveillance	40
10	39	Right lateral (sVII)	Surveillance	18
11	50	Right medial (sV)	Surveillance	21
12	92	Right lateral (sVI/VII)	Surveillance	43
13	111	Left lateral (sII/III)	Surveillance	92
Initially treated with intervention
14	90	Central (sIV/VIII)	No adenoma tissue after resection	-
15	55	Right medial (sVIII)	Surveillance	20
16	40	Right medial (sV/VIII)	RFA	0
17	73	Central (sIV/VIII)	Surveillance	40
18	80	Right lateral (sVI/VIII)	Surveillance	24
19	100	Left lateral (sII/III)	Surveillance	45
20	100	Central (sIV/V/VIII)	SAE	42
21	55	Right lateral (sVII)	Surveillance	38
22	25	Left lateral (sIII)	Surveillance	17
23	87	Right lateral (sVII)	Surveillance	62

RFA: Radiofrequency ablation; s: Liver segment; SAE: Selective arterial embolization. HCA: Hepatocellular adenoma.