Behavior and complications of hepatocellular adenoma during pregnancy and puerperium: a retrospective study and systematic review

Haring, Martijn P D; Spijkerboer, C.S.; Cuperus, Frans J. C.; Duiker, Evelien W.; Jong, Koert P. de; Haas, Robbert J. de; Meijer, Vincent E de

doi:10.1016/j.hpb.2021.04.019

Cited by 15 publications

(13 citation statements)

References 54 publications

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“…Pregnancy is no longer considered to be contraindicated in patients with HCA, 109 but close clinical follow‐up is recommended during the entire duration of the pregnancy, regardless of the size of the HCA as determined with frequent ultrasound monitoring, 8 as growth of the lesion and haemorrhage are potential complications. However, HCA of <50 mm seems to have a minimal risk of growth, 110 and haemorrhage was reported to be rare and associated with HCA of ≥65 mm, although it can be fatal 111 . Bleeding can be a major complication close to term and in the postpartum period in patients with b‐HCA with exon 3 S45 and exon 7/8 mutations 79 .…”

Section: Hca In Particular Clinicopathological Contextsmentioning

confidence: 99%

“…However, HCA of <50 mm seems to have a minimal risk of growth, 110 and haemorrhage was reported to be rare and associated with HCA of ≥65 mm, although it can be fatal. 111 Bleeding can be a major complication close to term and in the postpartum period in patients with b-HCA with exon 3 S45 and exon 7/8 mutations. 79 As yet, association of these complications with specific HCA subtypes during pregnancy is not established, because of limited data, partly because the diagnosis of HCA during pregnancy is not tissue-based.…”

Section: I V E R a D E N O M A T O S I S ( L A )mentioning

confidence: 99%

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Hepatocellular adenoma: what we know, what we do not know, and why it matters

et al. 2022

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Hepatocellular adenoma: what we know, what we do not know, and why it mattersIn the last two decades there has been significant progress in research on and diagnosis of hepatocellular adenoma (HCA), resulting in the establishment of a molecular and immunohistological HCA classification. This review aims to fine-tune the current expertise in order to enhance the histopathological diagnostic possibilities, by refining issues that are already known, addressing diagnostic difficulties, and identifying still unknown aspects of HCA. We discuss novel methods to identify HCA subtypes, in particular the sonic hedgehog HCAs and the interpretation of glutamine synthetase patterns for the recognition of b-cateninmutated HCAs. The major complications of HCAs, i.e. bleeding and malignant transformation, are considered, including the dilemmas of atypical and borderline lesions. HCAs in different clinical and geographical settings, e.g. pregnancy, cirrhosis and non-western countries, are also discussed. The natural history of the different HCA subtypes in relation to age, sex and risk factors is a feature that is still insufficiently investigated. This is also true for the risks of clinical bleeding and malignant transformation in association with HCA subtypes. As HCA is a relatively rare tumour, a multicentre and multidisciplinary approach across geographical boundaries will be the appropriate method to establish prospective programmes with which to identify, classify and manage HCAs, focusing on several aspects, e.g. aetiology, underlying liver disease, complications, regression, and growth. Updating what we know and identifying and addressing what we do not know matters for optimal patient management.

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Section: Hca In Particular Clinicopathological Contextsmentioning

confidence: 99%

Section: I V E R a D E N O M A T O S I S ( L A )mentioning

confidence: 99%

Hepatocellular adenoma: what we know, what we do not know, and why it matters

et al. 2022

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“…A major prospective study observed sub-5cm HCA to be safe during pregnancy, while a combined cohort study and systematic review observed only HCA-induced haemorrhages in HCA >6.5 cm and observed HCA to cause (lethal) postpartum haemorrhage in rare cases. 52 60 HCA smaller than 5 cm have been observed safe to discharge from follow-up after the menopause. 61 In addition, there has been reporting on the novel identification of sonic hedgehog activated HCA and roof plate-specific spondin 2 gene rearranged HCA, the increased application and accuracy of CEUS and MRI for diagnostics, occurrence of HCA in men prior to diabetic symptoms in HNF1A-MODY, and conservative and (minimally) invasive HCA management by transarterial embolisation.…”

Section: Discussionmentioning

confidence: 98%

“…Additional recommendations on liver disease during pregnancy, including BLT, can be found elsewhere. [50][51][52] Some liver transplantations have been performed for hepatocellular adenomatosis, yet this should not be applied standardly in the context of the current donor organ shortage and transplantation associated morbidity. 53 Both ACG and EASL made limited recommendations on the role of liver transplantation.…”

Section: Discussionmentioning

confidence: 99%

Scoping review of clinical practice guidelines on the management of benign liver tumours

Haring

Cuperus

Duiker

et al. 2021

BMJ Open Gastroenterol

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ObjectiveBenign liver tumours (BLT) are increasingly diagnosed as incidentalomas. Clinical implications and management vary across and within the different types of BLT. High-quality clinical practice guidelines are needed, because of the many nuances in tumour types, diagnostic modalities, and conservative and invasive management strategies. Yet, available observational evidence is subject to interpretation which may lead to practice variation. Therefore, we aimed to systematically search for available clinical practice guidelines on BLT, to critically appraise them, and to compare management recommendations.DesignA scoping review was performed within MEDLINE, EMBASE, and Web of Science. All BLT guidelines published in peer-reviewed, and English language journals were eligible for inclusion. Clinical practice guidelines on BLT were analysed, compared, and critically appraised using the Appraisal of Guidelines, Research and Evaluation (AGREE II) checklist regarding hepatic haemangioma, focal nodular hyperplasia (FNH), and hepatocellular adenoma (HCA). Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations (PRISMA) for scoping reviews were adhered to.ResultsThe literature search yielded unique 367 papers, 348 were excluded after screening of title/abstract, and 16 after full-text screening. Three guidelines were included: the American College of Gastroenterology (ACG; 2014), Brazilian Society of Hepatology (SBH; 2015), and European Association for the Study of the Liver (EASL; 2016). There was no uniformity in the assessment methods for grading and gravity of recommendations between guidelines. Among observed differences were: (1) indications for biopsy in all three tumours; (2) advices on contraceptive pills and follow-up in FNH and HCA; (3) use of an individualised approach to HCA; (4) absence of recommendations for treatment of HCA in men; and (5) approaches to HCA subtype identification on magnetic resonance imaging.ConclusionRecognising differences in recommendations can assist in harmonisation of practice standards and identify unmet needs in research. This may ultimately contribute to improved global patient care.

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“…Hepatocellular adenomas (HCAs) are benign liver tumors ( 1 ). The development of HCA can be stimulated by estrogen; pregnancy-associated increase in estrogen levels may therefore lead to HCA development ( 2 ). HCAs can be classified into six subtypes based on their genetic and histological features ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Inflammatory Hepatocellular Adenoma Mimicking Focal Nodular Hyperplasia That Grew during Pregnancy and Changed Its Appearance on Magnetic Resonance Imaging after Delivery

et al. 2023

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We reported a notable case of inflammatory hepatocellular adenoma that grew during pregnancy, consequently changing its appearance on magnetic resonance imaging remarkably. A 5-months-pregnant 35-yearold woman presented with a 37-mm liver nodule that had been diagnosed as focal nodular hyperplasia 3 years earlier. She had never used oral contraceptives. After 2 months, the nodule grew to 57 mm. The patient delivered a full-term infant without complications. Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging performed after delivery revealed markedly different findings compared with the first images. A liver biopsy was performed, and the tumor was diagnosed as inflammatory hepatocellular adenoma.

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Behavior and complications of hepatocellular adenoma during pregnancy and puerperium: a retrospective study and systematic review

Cited by 15 publications

References 54 publications

Hepatocellular adenoma: what we know, what we do not know, and why it matters

Hepatocellular adenoma: what we know, what we do not know, and why it matters

Scoping review of clinical practice guidelines on the management of benign liver tumours

Inflammatory Hepatocellular Adenoma Mimicking Focal Nodular Hyperplasia That Grew during Pregnancy and Changed Its Appearance on Magnetic Resonance Imaging after Delivery

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