A female patient with hepatocellular adenoma (liver cell adenoma) without a proven activated beta-catenin mutation, in whom the initial recommended conservative approach has not resulted in adequate lesion control at the expected reassessment point.
In women, the first-line step is lifestyle change — discontinuation of oral contraceptive pills (OCPs) and control of body weight — followed by reassessment at 6 months. This protocol applies when that approach has not met its goals: the adenoma has not remained below 5 cm, or has not stabilised or reduced in size at the 6-month follow-up.
When lifestyle modification proves insufficient, a curative interventional approach targeting the adenoma is indicated — with the specific modality and criteria guiding the choice detailed in the full structured protocol below.
DOI: 10.1016/j.jhep.2016.04.001
In women, a period of 6 months observation after lifestyle change is advised and resection is indicated for nodules equal or greater than 5 cm and those continuing to grow (evidence level II-3, grade of recommendation 2).
HCA persistently greater than 5 cm, or increasing in size (P20% diameter – as per RECIST criteria for solid malignant tumours) should be considered for resection or curative treatment – irrespective of their molecular or histological subtype – because of the risk of haemorrhage.
The recommended first line therapy is resection of larger (>5 cm) or growing lesions, aiming to remove the whole tumour and all risk of malignant transformation.
Non-surgical modalities, such as embolization for larger lesions or ablation for smaller lesions can be pursued as an alternative to resection, but this would only be the treatment of choice in poor surgical candidates.
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