HEPATOCELLULAR ADENOMA - THERAPEUTIC AND DIAGNOSTIC STRATEGY

While liver hemangioma and focal nodular hyperplasia are not considere d an indication for surgery in asymptomatic patients resection has bee n recommended for hepatocellular adenoma because of the risk of ruptur e and malignant transformation. Problems arise from differential diagn osis and the appropriate surgical radicality including the indication for liver transplantation. This retrospective analysis deals with 58 p atients who underwent surgery for hepatocellular adenoma: resection of different extension: n = 54, liver transplantation n = 4. In 39.6 % o f the patients the tumor was an incidental finding. In 62.0 % the char acter of the lesion was unclear prior to surgery. Tumor rupture and bl eeding occurred in 17.2 %, malignant transformation in 6.9 %. Surgical morbidity was 27.6 %, mortality 5.2 % with the transplant patients al ive for 1.5, 7, 9 and 10 years. Two and five years after resection 2 p atients developed hepatocellular carcinoma in the liver remnant. The r esults confirm the indication for surgery in hepatocellular adenoma. D iagnostic approach for solid liver tumors without serum increase of tu mor markers should rule out FNH and hemangioma. In all other patients surgery should be considered whenever possible with the radicality of malignant disease. Liver transplantation can be discussed Even in asym ptomatic patients with multiple adenoma.