Journal: Journal of gastrointestinal cancer
This publication is a narrative review focused on the current understanding and management of hepatic adenomas (HAs).
Key points:
- Epidemiology and risk factors
HAs are benign liver tumors with risks of hemorrhage and malignant transformation that rise with increasing tumor size.
They have been historically associated with estrogen-containing oral contraceptives.
Obesity and related metabolic factors are now recognized as important additional risk factors for HA development and growth.
- Risk stratification
Management is guided by:
- Tumor size (with >5 cm conferring higher risk)
- Symptoms
- Histologic subtype
- Patient-specific factors (e.g., sex, pregnancy status, comorbidities, number of lesions)
- Traditional management
Surgical resection has been the standard for:
- Large
- Symptomatic
- Or otherwise high-risk lesions (e.g., concern for malignant transformation or hemorrhage)
- Non-operative approaches
Active surveillance: appropriate for small (<5 cm), asymptomatic HAs lacking additional risk factors.
Loco-regional therapies:
- Transarterial embolization
- Radiofrequency ablation
These are used effectively, particularly for smaller tumors or in patients who are not ideal surgical candidates.
Weight-loss interventions:
- Lifestyle-based weight reduction and bariatric surgery are increasingly supported by evidence as effective in decreasing HA size.
- This has led to consideration of non-operative management even for some larger lesions (>5 cm) when they show regression with weight loss.
- Special populations
Particular attention is needed for:
- Pregnant patients
- Men
- Patients with hepatic adenomatosis
These groups require special consideration because their baseline risk profiles and management thresholds may differ.
- Overall conclusion
Management of HAs is shifting from a primarily surgical paradigm to a more nuanced, risk-adapted strategy.
A personalized, multidisciplinary approach is emphasized, incorporating surveillance, loco-regional therapies, weight-loss strategies, and emerging targeted options to minimize morbidity while maintaining safety.