Behavior and complications of hepatocellular adenoma during pregnancy and puerperium: a retrospective study and systematic review. Issue 8 (August 2021)

• Record Type: Journal Article
• Authors: Haring, Martijn P.D.; Spijkerboer, Christiaan S.; Cuperus, Frans J.C.; Duiker, Evelien W.; de Jong, Koert P.; de Haas, Robbert J.; de Meijer, Vincent E.
• Is Part Of: HPB. Volume 23:Issue 8(2021)
• Page Start: 1152
• Page End: 1163
• Publication Date: 2021-08
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1016/j.hpb.2021.04.019
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Background: Hepatocellular adenomas (HCA) are benign liver tumors at risk of hemorrhage. The influence of pregnancy on HCA growth and potential bleeding remains unclear. This study investigates HCA-associated behavior and bleeding complications during or shortly after pregnancy. Methods: (I) Single center retrospective cohort study of HCA during and after pregnancy (II) Systematic literature review. Results: The retrospective study included 11 patients, of which 4 with HCA ≥5 cm. In only two patients HCA showed growth during pregnancy. In this local cohort, no HCA-related hemorrhages occurred during median follow-up of 34 months (interquartile range 19–58 months). The systematic review yielded 33 studies, totaling 90 patients with 99 pregnancies. Of 73 pregnancies without prior HCA-related intervention, 39 HCA remained stable (53.4%), 11 regressed (15.1%), and 23 (31.5%) progressed. Fifteen HCA-related hemorrhages occurred in HCA measuring 6.5–17.0 cm. Eight patients experienced bleeding during pregnancy, two during labor and five postpartum. Conclusion: Although hemorrhage of HCA during or shortly after pregnancy is rare and only reported in HCA ≥6.5 cm, it can be fatal. Pregnancy in women with HCA, regardless of size, warrant a close surveillance strategy. Observational studies on behavior and management of HCA ≥5 cm during and immediately after pregnancy are needed.