A Scoping Review of the Classification, Diagnosis, and Management of Hepatic Adenomas

Abstract

Background: Hepatic adenomas (HA), or hepatocellular adenomas, are benign, solid liver lesions that develop in otherwise normal livers, often in the setting of increased estrogen levels. While considered a benign tumor, there is a risk for substantial complications such as hemorrhage and malignant transformation. We review the diagnosis, classification, and potential therapeutic management options for patients with HA. Methods: A scoping narrative review was conducted based on recent literature regarding classification, diagnosis, and management of HA. Results: While HAs are typically considered benign, complications such as hemorrhage and malignant transformation may occur in approximately 25% and 5% of patients, respectively. Recent advances in imaging and molecular profiling have allowed for the classification of HAs into subtypes allowing for patient risk stratification that helps guide management. Surgical resection should be considered in asymptomatic patients who are male, have an adenoma ≥5 cm in diameter, or have the β-catenin-activated subtype due to an increased risk of hemorrhage and/or malignant transformation. Conclusion: Molecular profiling has aided in the stratification of patients relative to the risk of complications to predict better the potential behavior of HAs.