Two clinical presentations of hepatocellular adenoma (HCA) carry a substantially elevated risk of malignant transformation: diagnosis in a male patient, and confirmed activated beta-catenin mutation. Both scenarios share a clear management direction that differs from other HCA presentations.
Male sex is a recognised high-risk feature in HCA, associated with a significantly higher incidence of malignant transformation. Similarly, a proven activated beta-catenin mutation in HCA tissue — identified through diagnostic sampling — defines another subgroup requiring proactive management, irrespective of lesion size.
Resection or curative intervention is the recommended approach in this setting, and lesion size does not alter this recommendation. In patients who are poor surgical candidates, non-surgical alternatives may be considered.
Specific selection criteria, intervention thresholds, and the full range of treatment options are detailed in the complete protocol.
DOI: 10.1016/j.jhep.2016.04.001
HCA resection is recommended irrespective of size in men and in any instance of proven β-catenin mutation (evidence level II-3, grade of recommendation 2).
Irrespective of size, however, resection or curative treatment is recommended for all HCA diagnosed in men because of a significantly higher incidence of malignant transformation.
In the case of tissue availability obtained for diagnostic purpose, curative intervention is advised for the activated b-catenin mutated HCA, irrespective of size.
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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