The Management of Pregnancy in Women with Hepatocellular Adenoma: A Plea for an Individualized Approach

Bröker, Mirelle; IJzermans, Jan N. M.; Aalten, Susanna M. van; Man, Robert A. de; Terkivatan, Türkan

doi:10.1155/2012/725735

Cited by 34 publications

(23 citation statements)

References 26 publications

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“…HCA requires special attention during pregnancy due to risk of increased growth and rupture, especially when lesions are greater than 5 cm (Cobey and Salem 2004). It is appropriate to closely observe patients with HCA during pregnancy if lesions are less than 5 cm with frequent ultrasound surveillance every 6-12 weeks (Br€ oker et al 2012). Due to the risk of adenoma growth during pregnancy, some investigators have proposed performing surgery, radiofrequency ablation, or embolization prior to pregnancy (Cobey and Salem 2004;Br€ oker et al 2012), but intensive medical treatment offers another option for managing these patients.…”

Section: Resultsmentioning

confidence: 99%

Regression of Hepatocellular Adenomas with Strict Dietary Therapy in Patients with Glycogen Storage Disease Type I

2014

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Hepatocellular adenomas (HCAs) are a common complication in patients with glycogen storage disease type I (GSD I). In this series, we report regression of HCAs in a cohort of patients who achieved metabolic control with strict dietary therapy. A retrospective review of the clinical records for all patients with GSD I was performed at our institution. All available imaging studies were reviewed in patients with reported regression of HCAs in the medical record. The charts of 163 patients with GSD Ia and 42 patients with GSD Ib were reviewed, and HCAs were documented in 47 subjects (43 Ia/4 Ib). After review of all available imaging studies, eight patients met criteria of being followed with both magnetic resonance imaging and ultrasound and were found to show evidence of regression of HCAs. In these individuals, regression of the HCAs occurred once metabolic control was obtained, as determined by decreasing levels of serum triglyceride levels. The average triglyceride level in all patients prior to regression of HCAs was 753 mg/dL (SD ± 293). The average serum triglyceride level in all patients at the time of regression of HCAs was 340 mg/dL (SD ± 164). These findings suggest that strict dietary therapy may cause regression of HCAs. If HCAs are documented in a patient with suboptimal metabolic control, intensive medical therapy may be an alternative to surgical intervention in some individuals.

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Section: Resultsmentioning

confidence: 99%

Regression of Hepatocellular Adenomas with Strict Dietary Therapy in Patients with Glycogen Storage Disease Type I

2014

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“…We advocate that patients with a HCA larger than 5 cm be treated before becoming pregnant. In cases where a HCA larger than 5 cm is found during pregnancy, the data are currently too sparse to draw firm conclusions, and we believe that the management in these patients should be individualized (36,37).…”

Section: Internal Bleeding In Hepatocellular Adenomamentioning

confidence: 97%

Genotype-phenotype correlations in hepatocellular adenoma: an update of MRI findings

Thomeer¹,

Bröker²,

Lussanet³

et al. 2014

Diagn Interv Radiol

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Hepatocellular adenoma (HCA) is a generally benign liver tumor with the potential for malignancy and bleeding. HCAs are categorized into four subtypes on the basis of genetic and pathological features: hepatocyte nuclear factor 1α-mutated HCA, β-catenin-mutated HCA, inflammatory HCA, and unclassified HCA. Magnetic resonance imaging (MRI) plays an important role in the diagnosis, subtype characterization, and detection of HCA complications; it is also used to differentiate HCA from focal nodular hyperplasia. In this review, we present an overview of the genetic abnormalities, oncogenesis, and typical and atypical MRI findings of specific subtypes of HCA using contrast-enhanced MRI with or without hepatobiliary contrast agents (gadobenate dimeglumine and gadoxetate disodium). We also discuss their different management implications after diagnosis.

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“…Pregnancy is no longer a contraindication in hepatocellular adenoma < 5 cm [43] . All fertile females with adenomas, aspiring pregnancy should discontinue use of exogenous hormone therapy if any.…”

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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The Management of Pregnancy in Women with Hepatocellular Adenoma: A Plea for an Individualized Approach

Cited by 34 publications

References 26 publications

Regression of Hepatocellular Adenomas with Strict Dietary Therapy in Patients with Glycogen Storage Disease Type I

Regression of Hepatocellular Adenomas with Strict Dietary Therapy in Patients with Glycogen Storage Disease Type I

Genotype-phenotype correlations in hepatocellular adenoma: an update of MRI findings

Hepatocellular adenoma: An update

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