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

Cobey, Frederick C.; Salem, Ronald R.

doi:10.1016/j.amjsurg.2003.11.016

Cited by 159 publications

(158 citation statements)

References 59 publications

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“…Some of these hemangiomas have estrogen receptors, and accelerated growth has been observed during estrogen influence during puberty, pregnancy, oral contraceptive use, and with androgen treatment. 26,46,48,49 Growing tumors are mainly seen in women. 49,50 In summary, for typical hemangiomas in an asymptomatic patient without risk factors for malignancy, conventional B-mode ultrasound is sufficient and no further imaging method is recommended.…”

Section: Discussionmentioning

confidence: 99%

Contrast‐enhanced ultrasound of histologically proven liver hemangiomas†

et al. 2007

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Differentiation of small and atypical hemangiomas from other hepatic masses using imaging methods can be difficult, especially in patients with underlying malignant disease. Therefore, contrast-enhanced ultrasound was assessed in patients with histologically confirmed hemangiomas with respect to contrast-enhancing kinetics and tumor characteristics. In 58 patients with indeterminate hepatic lesions demonstrated with at least 2 imaging methods (ultrasound/computed tomography/magnetic resonance imaging), ultrasound-guided liver biopsy revealed hemangioma. In all patients a hepatic neoplasm had been suspected because of underlying malignant disease (n ‫؍‬ 41), liver cirrhosis (n ‫؍‬ 15), or growth of the lesion (n ‫؍‬ 2). All patients underwent nonlinear, low mechanical index real-time contrast-enhanced ultrasound scanning with bolus injections of SonoVue. Peripheral nodular arterial enhancement was detected in 43 patients (74%), whereas the typical metastatic peripheral rim-like enhancement was not observed at all. Strong homogenous arterial enhancement was found in 9 of 58 (16%) patients. In 6 patients (10%), the arterial contrast enhancement pattern could not be determined because of the very small size of the lesions or fibrotic nodules. Forty-five (78%) of the hemangiomas showed homogenous centripetal filling within 180 seconds. Conclusion: Contrast-enhanced ultrasound demonstrates typical hemangioma imaging characteristics, that is, peripheral nodular contrast enhancement and iris-diaphragm sign in a high percentage of patients with undetermined lesions. This technique may therefore improve noninvasive functional characterization and differentiation of hemangiomas. (HEPATOLOGY 2007;45:1139-1145

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Section: Discussionmentioning

confidence: 99%

Contrast‐enhanced ultrasound of histologically proven liver hemangiomas†

et al. 2007

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“…In the last decennium, the introduction and widespread use of highly advanced image modalities have probably decreased the doctors' delay in the diagnosis of HCA and the associated maternal and fetal mortality risk might be reduced significantly. No ruptures associated with gestation were reported in tumours less than 6.5 cm in size [17]. In non pregnant women haemorrhage has been documented in a tumour of 4.5 cm in size but is most commonly seen in tumours greater than 10 cm [17].…”

Section: Introductionmentioning

confidence: 95%

“…No ruptures associated with gestation were reported in tumours less than 6.5 cm in size [17]. In non pregnant women haemorrhage has been documented in a tumour of 4.5 cm in size but is most commonly seen in tumours greater than 10 cm [17]. The risk of rupture is highest during the third trimester, most likely due to the cumulating level of estrogens and an increase in hyperdynamic circulation combined with an increase in vascularity of the liver with growth of the adenoma [17].…”

Section: Introductionmentioning

confidence: 98%

“…This differential diagnosis may lead to a diagnostic delay. Early detection of HCA and a correct management of these patients are highly important, since several manuscripts documented high maternal and fetal risks in case of a ruptured HCA during pregnancy with a reported maternal and fetal mortality rate of 44% and 38%, respectively [17]. In the last decennium, the introduction and widespread use of highly advanced image modalities have probably decreased the doctors' delay in the diagnosis of HCA and the associated maternal and fetal mortality risk might be reduced significantly.…”

Section: Introductionmentioning

confidence: 99%

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233 Management of Hepatocellular Adenoma During Pregnancy

Aalten¹,

Noels²,

Windt³

et al. 2010

Journal of Hepatology

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“…An increased level of endogenous hormones during pregnancy has been postulated towards the increase in size of adenomas during pregnancy. Pregnancy induced hyper dynamic circulation combined with increased liver vascularity may further increase the risk of adenoma rupture, most seen in the third trimester [42] . In the past, owing to high maternal and fetal mortality rates (44% and 38% respectively), fertile females with HCA were discouraged from pregnancy [42] .…”

Section: Malignant Transformationmentioning

confidence: 99%

Hepatocellular adenoma: An update

Vijay

Elaffandi

Khalaf

2015

WJH

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Hepatocellular adenomas (HCA) are rare benign liver tumors. Recent technological advancements have helped in the early identification of such lesions. However, precise diagnosis of hepatocellular incidentalomas remains challenging. Studies at the molecular level have provided new insights into the genetics and pathophysiology of these lesions. These in turn have raised questions over their existing management modalities.However, the rarity of the tumor still restricts the quality of evidence available for current recommendations and guidelines. This article provides a comprehensive review on the etiology, molecular biology, pathophysiology, clinical manifestations, and complications associated with HCA. It also elaborates on the genetic advancements, existing diagnostic tools and current guidelines for management for such lesions. Core tip: Hepatocellular adenomas despite being benign liver neoplasms often pose diagnostic and therapeutic challenges. Studies at the molecular level have provided new insights into the genetics and pathophysiology of these lesions. These in turn have raised questions over their existing management modalities. This article provides a comprehensive review and update on the topic.

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

Cited by 159 publications

References 59 publications

Contrast‐enhanced ultrasound of histologically proven liver hemangiomas†

Contrast‐enhanced ultrasound of histologically proven liver hemangiomas†

233 Management of Hepatocellular Adenoma During Pregnancy

Hepatocellular adenoma: An update

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