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Management of hepatocellular adenoma during pregnancy.

AbstractBACKGROUND & AIMS:
Hepatocellular adenoma in pregnant women requires special considerations because of the risk of hormone induced growth and rupture. To prevent these potential lethal complications, pregnancy is either often discouraged or the surgical resection of large adenomas is recommended. It may be questioned whether it is justified to deny a young woman a pregnancy, as the biological behaviour of hepatocellular adenoma may be less threatening than presumed. In this study we establish the management of hepatocellular adenoma during pregnancy based on our own experience and literature.
METHODS:
Twelve women with documented hepatocellular adenoma were closely monitored during a total of 17 pregnancies between 2000 and 2009. Their files were reviewed.
RESULTS:
In four cases, hepatocellular adenomas grew during pregnancy, requiring a Caesarean section in one patient (two pregnancies) at 36 and 34 weeks because of an assumed high risk of rupture. In one case radiofrequency ablation therapy was applied in the first trimester to treat a hormone sensitive hepatocellular adenoma, thereby excluding potential growth later in pregnancy. No intervention was performed in the other 14 cases and all pregnancies had an uneventful course with a successful maternal and fetal outcome.
CONCLUSIONS:
A "wait and see" management may be advocated in pregnant women presenting with a hepatocellular adenoma. In women with large tumours or in whom hepatocellular adenoma had complicated previous pregnancies, surgical resection may be recommended. In women with smaller adenomas it may no longer be necessary to discourage pregnancy.
AuthorsJohanna E Noels, Susanna M van Aalten, Dirk J van der Windt, Niels F M Kok, Rob A de Man, Turkan Terkivatan, Jan N M Ijzermans
JournalJournal of hepatology (J Hepatol) Vol. 54 Issue 3 Pg. 553-8 (Mar 2011) ISSN: 1600-0641 [Electronic] Netherlands
PMID21094555 (Publication Type: Case Reports, Journal Article)
CopyrightCopyright © 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Chemical References
  • Contraceptives, Oral
Topics
  • Adenoma, Liver Cell (complications, pathology, surgery, therapy)
  • Adult
  • Contraceptives, Oral (adverse effects)
  • Female
  • Humans
  • Liver Neoplasms (complications, pathology, surgery, therapy)
  • Magnetic Resonance Imaging
  • Pregnancy
  • Pregnancy Complications, Neoplastic (pathology, surgery, therapy)
  • Pregnancy Outcome
  • Retrospective Studies
  • Risk Factors
  • Rupture, Spontaneous (prevention & control)
  • Watchful Waiting
  • Young Adult

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