A review of liver masses in pregnancy and a proposed

algorithm for their diagnosis and management

Frederick C. Cobey, M.D., M.P.H., Ronald R. Salem, M.D.

The American Journal of Surgery 187 (2004) 181-191

◦ Literature Review Medline search from 1966 to 2002 keywords:

Hepatic mass Pregnancy Adenoma Focal nodular hyperplasia Hemangioma

26 pregnancies with liver cell adenomas were identified◦ 7 additional illustrative cases of liver masses during

pregnancy from the Department of Surgery of The Yale University School of Medicine 1 pregnancy with liver cell adenoma

Methods

Results

Aggressive approach to resection of LCA >5 cm should be seriously considered in pregnancy.

Small asymptomatic LCAs (<5 cm) may be observed during the course of pregnancy and may not require immediate surgical intervention

For smaller lesions early in pregnancy an aggressive approach to resections is suggested if an increase of the size is observed

Recommendations

Management of hepatocellular adenoma

during pregnancyJohanna 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

Jounal of Hepatology 2010

Between January 2000 and December 2009 The Erasmus Medical Center recorded all data of patients with LCA

Those patients were advised to discontinue the use of oral contraceptive and prevent pregnancy

11 patients got pregnant nevertheless and were closely monitored by ultrasound and/or MR imaging. (In 1 patient LCA was diagnosed during pregnancy)

Methods

Presentation before pregnancy:◦ 4 patients were symptomatic (pain right flank)◦ 5 patients had unspecific complaints (abdominal

pain)◦ 2 patients were asymptomatic

Adenoma size at time of diagnosis:◦ 7 patients: <5 cm◦ 5 patients: >5 cm

These 12 patients were monitored during a total of 17 pregnancies

Patient caracteristics

Growth:◦ In 4 pregnancies: Growth◦ In 11 pregnancies: No growth/regression observed◦ In 1 pregnancy: Minimal regression◦ In 1 pregnancy: unknown

Interventions during pregnancy: ◦ 3 Cesarian sections, 1 radiofrequency ablation

All pregnancies had an uneventful course with a successful maternal and fetal outcome

Results

Pregnancy may be allowed to women with small tumors (<5 cm). Yet, close monitoring is proposed.

In women who have large tumors or who have experienced complications of LCA in previous pregnancies, a negative advice against pregnancy is justified because of an increased risk of complications.◦ In that case, surgical resection should be

recommended before pregnancy.

Recommendations

From: Management of Hepatocellular Adenoma: Recent AdvancesShefali Agrawal, Sheela Agarwal, Thomas Arnason, Sanjay Saini, Jacques BelghitiClinical Gastroenterology and Hepatology 2015;13:1221-1230

Summary

Summary

Summary