Hepatocellular adenomas – patient selection challenges and diagnostic pitfalls

Backgrounds: Hepatocelullar adenomas (HCA) are rare and liver resection has been traditionally recommended to prevent or treat malignant transformation and haemorrhege. Despite of new immunohistochemistry diagnostic protocols, surgery remains frequently indicated for nodules that exceed 5cm. In this study we aim the results of surgical treatment of HCA with emphasis on patient selection, results and confounding tumors. Methods: Data from patients operated on from July 2007 and August 2015 were reviewed. Patients with HCA as primary diagnosis, suspected malignancy or bleeding tumors were included. Exclusion criteria were cirrhosis and chronic liver disease. The standard imaging of reference were either MRI or CT scans. Results were expressed as frequencies and median values. Results: Fifteen patients were included. Thirteen females. Five patients complained of abdominal pain (38%), two (13%) received emergency treatment. Six patients (40%) had HCA as primary diagnosis, seven (47%) had suspected malignancy and two (13%) complicated tumors. CT/MRI imaging revealed single nodules in ten (67%) patients and multiple in five (33%). Surgical treatment consisted of one right hepatectomy, one lap left lateral sectorectomy, one lap left hepatectomy and eleven segmentectomies – nodulectomies. Histological results: < 5cm: 1 fibrous tumor, 1 HCA, 3 Focal Nodular Hyperplasia. 5 – 10cm: 3 HCA, 4 FNH. > 10cm: 2 HCA, 1 HCA/HCC. Conclusions: Both lap and conventional HCA resections are safe and surgical morbidity is low. Confounding diagnosis include mainly FNH but also fibrous tumor and HCC. Imaging accuracy is limited for tumors < 5m and suspected malignancy may warrant unnecessary liver resection.