Behavior and complications of hepatocellular adenoma during pregnancy and puerperium: a retrospective study and systematic review

Martijn P D Haring, Christiaan S Spijkerboer, Frans J C Cuperus, Evelien W Duiker, Koert P de Jong, Robbert J de Haas, Vincent E de Meijer*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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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.

Original languageEnglish
Pages (from-to)1-12
Number of pages12
JournalHpb
DOIs
Publication statusE-pub ahead of print - 28-Apr-2021

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