Laboratory of Experimental Surgery and Surgical Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Department of Surgery, Division of Surgical Oncology, University of Wisconsin Hospital, Madison, WI, USA.
J Gastrointest Surg. 2019 Jan;23(1):199-209. doi: 10.1007/s11605-018-3917-4. Epub 2018 Aug 14.
Hepatic adenomas (HAs) are a benign and relatively rare type of liver neoplasms. We review the diagnosis, evaluation, and potential therapeutic management options for patients with HA.
A comprehensive review of the English literature was performed utilizing MEDLINE/PubMed and Web of Science databases with end of search date the 30th April of 2018. In PubMed, the terms "hepatocellular," "hepatic," "liver," and "adenoma," "adenomatosis" were searched in the title and/or abstract.
Recent advances in molecular classification of HA have determined distinct subtypes with specific clinical, pathological, and imaging characteristics. In general, cessation of exogenous hormonal administration or weight loss may lead to HA regression. Surgical resection, either open or laparoscopic, should be considered in patients with symptoms and risk factors for hemorrhage or malignant transformation. These risk factors include tumor diameter greater than 5 cm, β-catenin activated subtype, and/or male gender. The management of acute hemorrhage should primarily aim at achieving hemodynamic stability via angioembolization followed by elective resection, whereas malignant transformation is treated according to oncologic resection principles. Although pregnancy is one of the known risk factors for tumor growth and associated complications, the presence of an HA per se should not be considered a contradiction to pregnancy.
Future genomic-based multicenter studies are required to provide a strong basis for formulating an evidence-based risk-adapted model that guides individualized management strategies for patients with HA.
肝腺瘤（HAs）是一种良性且相对罕见的肝脏肿瘤。我们回顾了 HA 患者的诊断、评估和潜在治疗管理选择。
利用 MEDLINE/PubMed 和 Web of Science 数据库进行了全面的英文文献综述，检索截止日期为 2018 年 4 月 30 日。在 PubMed 中，在标题和/或摘要中搜索了“肝细胞”、“肝”、“肝脏”和“腺瘤”、“腺瘤病”等术语。
HA 的分子分类的最新进展确定了具有特定临床、病理和影像学特征的不同亚型。一般来说，停止外源性激素治疗或减肥可能会导致 HA 消退。对于有出血或恶变风险因素的患者，应考虑手术切除，无论是开放性还是腹腔镜下。这些风险因素包括肿瘤直径大于 5 厘米、β-连环蛋白激活亚型和/或男性。急性出血的治疗主要应通过血管栓塞实现血流动力学稳定，然后进行选择性切除，而恶性转化则根据肿瘤切除原则进行治疗。虽然妊娠是肿瘤生长和相关并发症的已知危险因素之一，但 HA 的存在本身不应被视为妊娠的禁忌症。
需要进行基于基因组的未来多中心研究，为制定基于证据的风险适应模型提供坚实的基础，指导 HA 患者的个体化管理策略。
