Diagnosis and Treatment of Hepatocellular Adenoma in the Netherlands: Similarities and Differences

Abstract

Background: The diagnosis of hepatocellular adenoma (HA) has a great impact on the lives of young women and may pose clinical dilemmas to the clinician since there are no standardized protocols to follow. We aimed to establish expert opinions on diagnosis and treatment of HA by collecting data from a nationwide questionnaire in the Netherlands. Methods: A questionnaire was sent to 20 Dutch hospitals known to offer hepatologic and surgical experience on liver tumours. Results: 17 hospitals (85%) responded to the questionnaire. Annually, a median of 52 patients presented with a solid liver tumour. In 15 (88%) hospitals, hepatic adenomas were diagnosed with contrast-enhanced, multiphase spiral CT or MRI. In 2 (12%) hospitals, histology was required as part of a management protocol. Surveillance after withdrawal of oral contraceptives was the initial policy in all clinics. MRI, CT or ultrasound was used for follow-up. Criteria for surgical resection were a tumour size >5 cm and abdominal complaints. In 5 (29%) hospitals, patients were dismissed from follow-up after surgery. In complex cases (e.g. large, multiple or centrally localized lesions, a wish for pregnancy), the treatment policy was highly variable. Pregnancy was not discouraged in 15 hospitals, but in 11 (65%) of these, strictly defined conditions were noted: frequent follow-up, peripheral tumour localization that makes surgery easier if necessary, stable tumour size, and a good informed consent. Conclusion: The management of HAs in the Netherlands is rather uniform, except in complex cases in which multiple factors may influence policy.

Immunohistochemical Markers on Needle Biopsies Are Helpful for the Diagnosis of Focal Nodular Hyperplasia and Hepatocellular Adenoma Subtypes

“…[1][2][3][4][5] Molecular studies have allowed the distinction of FNH from HCA, confirming that FNH lesions are polyclonal with b-catenin activation without mutation. 6 In addition, FNH lesions exhibit a particular glutamine synthetase (GS) staining in a characteristic "map-like" pattern but do not express inflammatory proteins such as serum amyloid A (SAA) or C reactive protein (CRP) or show aberrant b-catenin nuclear staining.…”

Liver transplantation for recurrent hepatic adenoma

“…Clinical observation is indicated in small adenomas less than 4 cm in diameter and for lesions that show a regression after stopping oral contraceptives (OC). Surgical resection should be taken into consideration in cases in which the risk of complication (bleeding and malignant transformation) is increased, in female patients with a wish for pregnancy with HA ≥ 5 cm, in post-menopausal women with HA > 5 cm after 6 mo of stop OC and in males regardless of HA size due to the high risk of β-catenin mutation [9,14] . It is more controversial the management of patients with multiple HA.…”

Pregnancy and liver adenoma management: PALM-study

“…Surgical resection is also indicated if there is diagnostic doubt e.g. whether a tumor is malignant [18,19]. …”

“…Most experts advocate that women with HCA should not get pregnant or advise surgical resection before pregnancy [2,18]. Cobey et al reported a maternal and fetal mortality risk of ruptured HCA during pregnancy of 44% and 38%, respectively [20].…”