Surgical strategies for liver cell adenoma

Abstract

Liver cell adenomas (LCA) are benign tumors that occur primarily in women with a history of oral contraceptive use. While rare, LCA are clinically important because of their propensity for sudden, unpredictable hemorhage or malignant transformation. Differentiation from focal nodular hyperplasia or hepatocellular carcinoma may be difficult even with sophisticated imaging modalities. Current management guidelines are based on the presence or absence of symptoms, the certainty of diagnosis, and the response, if any, to withdrawing putative growth stimuli. Complete excision, sparing as much normal liver as possible, is generally recommended, except in patients with adenomatosis. This may require anatomical resection (either lobectomy or segmentectomy), local wedge excision, or enucleation. Rarely, orthotopic liver transplantation may be required in patients with large, centrally placed lesions, recurrence following previous resection(s), or adenomatosis. Nonsurgical ablation techniques such as interstitial radio-frequency or laser hyperthermia and cryotherapy may also be useful in selected patients.