Management of hepatocellular adenoma in women

HCA: hepatocellular adenoma; MRI: magnetic resonance imaging.
* Male patients with HCA are referred for surgical intervention regardless of the size of the lesion.
¶ Patients with HCA complicated by bleeding may present with acute abdominal pain with or without hemodynamic instability; the diagnosis is confirmed on imaging.
Δ Transarterial embolization is performed as initial therapy for most patients with HCA complicated by bleeding.
◊ For asymptomatic women with a lesion >5 cm in the setting of oral contraceptives, discontinuing oral contraceptives and obtaining repeat imaging in 6 to 12 months is a reasonable option. If lesion size remains >5 cm, surgical resection is typically performed.
§ We obtain contrast–enhanced MRI in 6 months and then annually thereafter, provided that the lesion is not growing (ie, ≥20% increase in diameter) and is not >5 cm in size.
¥ Alternatives to surgical resection include transarterial embolization and radiofrequency ablation.