Regional Therapies for Hepatic Adenoma

Abstract

Hepatic adenomas (HAs) are a rare and benign disease primarily affecting a young and otherwise healthy patient population, but the risk of hemorrhage and malignant transformation makes identification and treatment crucial. HAs may present with abdominal pain, but are most often discovered incidentally. Accurate diagnosis of HA is important to properly risk stratify patients. Cross-sectional imaging can often diagnose HA and distinguish it from FNH without the need for core needle biopsy. The most important characteristics guiding treatment of HA are the tumor size, anatomic location, and the patient’s gender. Any patient presenting with an HA-associated hemorrhage or rupture should be treated emergently with hepatic artery embolization to stabilize the patient, and resection should be strongly considered.

Asymptomatic patients with HA deemed to be at risk for hemorrhage or malignancy should undergo a treatment of a definitive nature. Unresectable tumors may be treated with hepatic artery embolization (HAE) or ablation. These regional therapies may result in long-term resolution of the disease, or may improve the operative outcomes. Although most HA are currently resected, several institutions and small case series have reported success with HAE or ablation as an alternative.