Journal of Gastrointestinal Surgery

, Volume 23, Issue 1, pp 199–209 | Cite as

Current Approaches in the Management of Hepatic Adenomas

  • Diamantis I. Tsilimigras
  • Amir A. Rahnemai-Azar
  • Ioannis Ntanasis-Stathopoulos
  • Maria Gavriatopoulou
  • Demetrios Moris
  • Eleftherios Spartalis
  • Jordan M. Cloyd
  • Sharon M. Weber
  • Timothy M. PawlikEmail author
Review Article



Hepatic adenomas (HAs) are a benign and relatively rare type of liver neoplasms. We review the diagnosis, evaluation, and potential therapeutic management options for patients with HA.


A comprehensive review of the English literature was performed utilizing MEDLINE/PubMed and Web of Science databases with end of search date the 30th April of 2018. In PubMed, the terms “hepatocellular,” “hepatic,” “liver,” and “adenoma,” “adenomatosis” were searched in the title and/or abstract.


Recent advances in molecular classification of HA have determined distinct subtypes with specific clinical, pathological, and imaging characteristics. In general, cessation of exogenous hormonal administration or weight loss may lead to HA regression. Surgical resection, either open or laparoscopic, should be considered in patients with symptoms and risk factors for hemorrhage or malignant transformation. These risk factors include tumor diameter greater than 5 cm, β-catenin activated subtype, and/or male gender. The management of acute hemorrhage should primarily aim at achieving hemodynamic stability via angioembolization followed by elective resection, whereas malignant transformation is treated according to oncologic resection principles. Although pregnancy is one of the known risk factors for tumor growth and associated complications, the presence of an HA per se should not be considered a contradiction to pregnancy.


Future genomic-based multicenter studies are required to provide a strong basis for formulating an evidence-based risk-adapted model that guides individualized management strategies for patients with HA.


Adenoma Adenomatosis Liver Hepatic HNF-1α β-Catenin JAK-STAT pathway 


Compliance with Ethical Standards

Conflict of Interest

None declared.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Diamantis I. Tsilimigras
    • 1
  • Amir A. Rahnemai-Azar
    • 2
  • Ioannis Ntanasis-Stathopoulos
    • 3
  • Maria Gavriatopoulou
    • 3
  • Demetrios Moris
    • 4
  • Eleftherios Spartalis
    • 1
  • Jordan M. Cloyd
    • 4
  • Sharon M. Weber
    • 2
  • Timothy M. Pawlik
    • 4
    • 5
    Email author
  1. 1.Laboratory of Experimental Surgery and Surgical Research, School of MedicineNational and Kapodistrian University of AthensAthensGreece
  2. 2.Department of Surgery, Division of Surgical OncologyUniversity of Wisconsin HospitalMadisonUSA
  3. 3.Department of Clinical Therapeutics, School of MedicineNational and Kapodistrian University of Athens, Alexandra General HospitalAthensGreece
  4. 4.Department of Surgery, Division of Surgical OncologyThe Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research InstituteColumbusUSA
  5. 5.Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Oncology, Health Services Management and PolicyThe Ohio State University, Wexner Medical CenterColumbusUSA

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