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[Hepatocellular adenoma in 20 patients; recommendations for treatment]
J H de Wilt1, R A de Man, J S Laméris
1Afd. Algemene Heelkunde, Academisch Ziekenhuis Rotterdam-Dijkzigt, Rotterdam.
Objective:
Analysis of the diagnostic approach and management of 20 patients with hepatocellular adenoma, 1979-1996.
Setting:
University Hospital Rotterdam-Dijkzigt, Rotterdam, the Netherlands.
Design:
Retrospective and follow-up analysis.
Method:
Medical records of patients with histologically proven hepatocellular adenoma were analysed with respect to complaints, diagnostic approach and therapeutical management. Follow-up took place at the outpatient department where history-taking, physical examination, ultrasonography and hepatitis B and C serology tests were performed.
Results:
In the period 1979-1996, 20 patients with hepatocellular adenoma were treated. Eight patients (mean tumour size 3.2 cm (1.5-5)) were treated conservatively, 12 (mean tumour size 8.1 cm (6-10)) underwent hepatic resection; four because of rupture of the tumour. Serum liver enzyme values did not contribute to the diagnosis. Of the lesions 78% were diagnosed correctly by ultrasonography and 71% by computer tomography. Median follow-up of the patients treated operatively was 73 months (1-204). One patient died three years after an incomplete resection of a hepatocellular adenoma, because of a hepatocellular carcinoma. Ultrasonography did not demonstrate any recurrent tumours in the other patients. In the group of patients conservatively treated (median follow-up 39 months (24-72)) two patients died because of a hepatocellular carcinoma. Ultrasonography demonstrated stable tumour diameters in three patients and regression in three others.
Conclusion:
Based on the literature and the presented experience surgical treatment is the treatment of choice in patients with large (> or = 5 cm diameter) hepatocellular adenomas because of the risk of malignant transformation and rupture of the tumour. With smaller tumours (< 5 cm) a conservative treatment may suffice in hepatitis virus negative patients, including withdrawal of oral contraceptives followed by thorough ultrasound follow-up of tumour size. In case of tumour growth or complaints a resection of the tumour is indicated.