[Small nodules of adenomatous hyperplasia in the cirrhotic liver. Treatment with percutaneous alcoholization].

Small adenomatous hyperplastic nodules (AHNs) are now detected with increasing frequency in cirrhotic livers thanks to the widespread use of ultrasonography (US) in patients with chronic liver disease. The management of these lesions, which are commonly considered as likely to evolve into hepatocellular carcinomas (HCCs), is difficult: indeed, the surgical resection of a questionable neoplastic lesion does not seem advantageous, if surgical hazards are considered; on the contrary, the simple US/bioptic follow-up may be untimely in the detection of the malignant transformation. Percutaneous ethanol injection (PEI) under US guidance, already employed in the treatment of small HCCs, was recently proposed as a viable therapeutic alternative for AHNs. Our experience includes 16 AHNs submitted to PEI over a 2-year period. The size of the lesions ranged between 0.7 and 2.3 cm. Each nodule was treated on an outpatient basis with 6 weekly ethanol injections; the total amount of alcohol delivered to each lesion was 8-17 ml. No complications occurred. PEI induced volumetric reduction and/or structural modifications of the lesions; 10 of them were hardly differentiable from the surrounding parenchyma at the end of treatment. One month after PEI, CT allowed the detection of 13/16 AHNs; all of them resulted hypodense and showed no contrast enhancement. Repeated biopsies produced necrotic material in all cases. During the follow-up (10-33 months, mean 18.3) no recurrences were observed. At the moment, PEI seems to be the most appropriate therapeutic approach for small AHNs.