Chirurgie bei gutartigen soliden Lebertumoren

Diese Übersicht konzentriert sich auf die drei häufigsten gutartigen Lebertumoren – hepatische Hämangiome, fokale noduläre Hyperplasien und hepatozelluläre Adenome – und bietet einen Überblick über die klinischen Präsentationen, das diagnostische Vorgehen, das konservative Management sowie die interventionelle und chirurgische Behandlung.

Kernaussagen

• Asymptomatische typische hepatische Hämangiome (HH) bedürfen keiner Therapie oder bildgebenden Nachsorge.

• Bei Patientinnen mit Leberhämangiom ist eine Schwangerschaft oder die Einnahme von Antikonzeptiva nicht kontraindiziert.

• Hämangiome sollten nur im Falle von Symptomen, Komplikationen, der Größenzunahme oder eines Kasabach-Merritt-Syndroms therapiert werden.

• Bei asymptomatischen fokalen nodulären Hyperplasien (FNH), unabhängig von ihrer Größe, ist kein Eingriff erforderlich.

• Hepatozelluläre Adenome (HCA) bei Männern sollten unabhängig von der Größe reseziert werden.

• Bei Frauen mit einem HCA von mehr als 5 cm Durchmesser und nach Absetzen der Hormontherapie wird eine chirurgische Behandlung empfohlen.

Schlüsselwörter

Benigne Lebertumoren - Leberhämangiom - fokale noduläre Hyperplasie - Leberadenom

Publication History

Article published online:
02 February 2021

• Literatur

• 1 de Knegt RJ, Potthoff A, Wirth T. Management benigner Lebertumoren. Internist 2020; 61: 140-146 doi:10.1007/s00108-019-00736-5
• 2 European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of benign liver tumours. J Hepatol 2016; 65: 386-398 doi:10.1016/j.jhep.2016.04.001
• 3 Marrero JA, Ahn J, Rajender Reddy K. et al. ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol 2014; 109: 1328-1347 quiz 1348 doi:10.1038/ajg.2014.213
• 4 Buetow PC, Pantongrag-Brown L, Buck JL. et al. Focal nodular hyperplasia of the liver: radiologic-pathologic correlation. Radiographics 1996; 16: 369-388 doi:10.1148/radiographics.16.2.8966294
• 5 Vilgrain V, Flejou JF, Arrive L. et al. Focal nodular hyperplasia of the liver: MR imaging and pathologic correlation in 37 patients. Radiology 1992; 184: 699-703 doi:10.1148/radiology.184.3.1509052
• 6 Brancatelli G, Federle MP, Grazioli L. et al. Focal nodular hyperplasia: CT findings with emphasis on multiphasic helical CT in 78 patients. Radiology 2001; 219: 61-68 doi:10.1148/radiology.219.1.r01ap0361
• 7 Dietrich CF, Schuessler G, Trojan J. et al. Differentiation of focal nodular hyperplasia and hepatocellular adenoma by contrast-enhanced ultrasound. Br J Radiol 2005; 78: 704-707 doi:10.1259/bjr/88181612
• 8 Kim MJ, Lim HK, Kim SH. et al. Evaluation of hepatic focal nodular hyperplasia with contrast-enhanced gray scale harmonic sonography: initial experience. J Ultrasound Med 2004; 23: 297-305 doi:10.7863/jum.2004.23.2.297
• 9 Stark DD, Felder RC, Wittenberg J. et al. Magnetic resonance imaging of cavernous hemangioma of the liver: tissue-specific characterization. AJR Am J Roentgenol 1985; 145: 213-222 doi:10.2214/ajr.145.2.213
• 10 Kehagias D, Moulopoulos L, Antoniou A. et al. Focal nodular hyperplasia: imaging findings. Eur Radiol 2001; 11: 202-212 doi:10.1007/s003300000575
• 11 Mortele KJ, Praet M, Van Vlierberghe H. et al. CT and MR imaging findings in focal nodular hyperplasia of the liver: radiologic-pathologic correlation. AJR Am J Roentgenol 2000; 175: 687-692 doi:10.2214/ajr.175.3.1750687
• 12 Laumonier H, Bioulac-Sage P, Laurent C. et al. Hepatocellular adenomas: magnetic resonance imaging features as a function of molecular pathological classification. Hepatology 2008; 48: 808-818 doi:10.1002/hep.22417
• 13 Ronot M, Bahrami S, Calderaro J. et al. Hepatocellular adenomas: accuracy of magnetic resonance imaging and liver biopsy in subtype classification. Hepatology 2011; 53: 1182-1191 doi:10.1002/hep.24147
• 14 Toro A, Mahfouz AE, Ardiri A. et al. What is changing in indications and treatment of hepatic hemangiomas. A review. Ann Hepatol 2014; 13: 327-339
• 15 Glinkova V, Shevah O, Boaz M. et al. Hepatic haemangiomas: possible association with female sex hormones. Gut 2004; 53: 1352-1355 doi:10.1136/gut.2003.038646
• 16 Ozakyol A, Kebapci M. Enhanced growth of hepatic hemangiomatosis in two adults after postmenopausal estrogen replacement therapy. Tohoku J Exp Med 2006; 210: 257-261 doi:10.1620/tjem.210.257
• 17 Donati M, Stavrou GA, Donati A. et al. The risk of spontaneous rupture of liver hemangiomas: a critical review of the literature. J Hepatobiliary Pancreat Sci 2011; 18: 797-805 doi:10.1007/s00534-011-0420-7
• 18 Kasabach HH, Merritt KK. Capillary hemangioma with extensive purpura: report of a case. Am J Dis Child 1940; 59: 1063-1070 doi:10.1001/archpedi.1940.01990160135009
• 19 Srivastava DN, Gandhi D, Seith A. et al. Transcatheter arterial embolization in the treatment of symptomatic cavernous hemangiomas of the liver: a prospective study. Abdom Imag 2001; 26: 510-514 doi:10.1007/s00261-001-0007-x
• 20 Furumaya A, van Rosmalen BV, Takkenberg RB. et al. Transarterial (Chemo-)Embolization and Lipiodolization for Hepatic Haemangioma. Cardiovasc Intervent Radiol 2019; 42: 800-811 doi:10.1007/s00270-019-02169-x
• 21 Hoffmann K, Schemmer P. Benigne solide Tumoren der Leber. Allgemein- und Viszeralchirurgie up2date 2011; 5: 135-146 doi:10.1055/s-0030-1270890
• 22 Rubin RA, Mitchell DG. Evaluation of the solid hepatic mass. Med Clin North Am 1996; 80: 907-928 doi:10.1016/s0025-7125(05)70473-9
• 23 Sempoux C, Paradis V, Komuta M. et al. Hepatocellular nodules expressing markers of hepatocellular adenomas in Budd-Chiari syndrome and other rare hepatic vascular disorders. J Hepatol 2015; 63: 1173-1180 doi:10.1016/j.jhep.2015.06.017
• 24 Bioulac-Sage P, Cubel G, Balabaud C. et al. Revisiting the pathology of resected benign hepatocellular nodules using new immunohistochemical markers. Sem Liver Dis 2011; 31: 91-103 doi:10.1055/s-0031-1272837
• 25 Roche V, Pigneur F, Tselikas L. et al. Differentiation of focal nodular hyperplasia from hepatocellular adenomas with low-mechanical-index contrast-enhanced sonography (CEUS): effect of size on diagnostic confidence. Eur Radiol 2015; 25: 186-195 doi:10.1007/s00330-014-3363-y
• 26 Bertin C, Egels S, Wagner M. et al. Contrast-enhanced ultrasound of focal nodular hyperplasia: a matter of size. Eur Radiol 2014; 24: 2561-2571 doi:10.1007/s00330-014-3280-0
• 27 Ramirez-Fuentes C, Marti-Bonmati L, Torregrosa A. et al. Variations in the size of focal nodular hyperplasia on magnetic resonance imaging. Radiologia 2013; 55: 499-504 doi:10.1016/j.rx.2011.12.008
• 28 Rifai K, Mix H, Krusche S. et al. No evidence of substantial growth progression or complications of large focal nodular hyperplasia during pregnancy. Scand J Gastroenterol 2013; 48: 88-92 doi:10.3109/00365521.2012.737361
• 29 Baum JK, Bookstein JJ, Holtz F. et al. Possible association between benign hepatomas and oral contraceptives. Lancet 1973; 2: 926-929 doi:10.1016/s0140-6736(73)92594-4
• 30 Ribeiro A, Burgart LJ, Nagorney DM. et al. Management of liver adenomatosis: results with a conservative surgical approach. Liver Transplant Surg 1998; 4: 388-398 doi:10.1002/lt.500040505
• 31 Rooks JB, Ory HW, Ishak KG. et al. Epidemiology of hepatocellular adenoma. The role of oral contraceptive use. JAMA 1979; 242: 644-648
• 32 Steinbrecher UP, Lisbona R, Huang SN. et al. Complete regression of hepatocellular adenoma after withdrawal of oral contraceptives. Digest Dis Sci 1981; 26: 1045-1050 doi:10.1007/BF01314771
• 33 Martin NM, Abu Dayyeh BK, Chung RT. Anabolic steroid abuse causing recurrent hepatic adenomas and hemorrhage. World J Gastroenterol 2008; 14: 4573-4575 doi:10.3748/wjg.14.4573
• 34 Bunchorntavakul C, Bahirwani R, Drazek D. et al. Clinical features and natural history of hepatocellular adenomas: the impact of obesity. Aliment Pharmacol Ther 2011; 34: 664-674 doi:10.1111/j.1365-2036.2011.04772.x
• 35 Nault JC, Paradis V, Cherqui D. et al. Molecular classification of hepatocellular adenoma in clinical practice. J Hepatol 2017; 67: 1074-1083 doi:10.1016/j.jhep.2017.07.009
• 36 Dokmak S, Paradis V, Vilgrain V. et al. A single-center surgical experience of 122 patients with single and multiple hepatocellular adenomas. Gastroenterology 2009; 137: 1698-1705 doi:10.1053/j.gastro.2009.07.061
• 37 Pilati C, Letouze E, Nault JC. et al. Genomic profiling of hepatocellular adenomas reveals recurrent FRK-activating mutations and the mechanisms of malignant transformation. Cancer Cell 2014; 25: 428-441 doi:10.1016/j.ccr.2014.03.005
• 38 Zheng J, Sadot E, Vigidal JA. et al. Characterization of hepatocellular adenoma and carcinoma using microRNA profiling and targeted gene sequencing. PLoS One 2018; 13: e0200776 doi:10.1371/journal.pone.0200776
• 39 Bajenaru N, Balaban V, Savulescu F. et al. Hepatic hemangioma-review. J Med Life 2015; 8 Spec Issue: 4-11
• 40 Weimann A, Ringe B, Klempnauer J. et al. Benign liver tumors: differential diagnosis and indications for surgery. World J Surg 1997; 21: 983-990 discussion 990-981 doi:10.1007/s002689900337
• 41 Vogl TJ, Own A, Hammerstingl R. et al. Transarterial embolization as a therapeutic option for focal nodular hyperplasia in four patients. Eur Radiol 2006; 16: 670-675 doi:10.1007/s00330-005-2885-8
• 42 van Rosmalen BV, de Graeff JJ, van der Poel MJ. et al. Impact of open and minimally invasive resection of symptomatic solid benign liver tumours on symptoms and quality of life: a systematic review. HPB (Oxford) 2019; 21: 1119-1130 doi:10.1016/j.hpb.2019.02.022
• 43 Agrawal S, Agarwal S, Arnason T. et al. Management of Hepatocellular Adenoma: Recent Advances. Clin Gastroenterol Hepatol 2015; 13: 1221-1230 doi:10.1016/j.cgh.2014.05.023
• 44 Di Sandro S, Slim AO, Lauterio A. et al. Liver adenomatosis: a rare indication for living donor liver transplantation. Transplant Proc 2009; 41: 1375-1377 doi:10.1016/j.transproceed.2009.03.021
• 45 Chiche L, David A, Adam R. et al. Liver transplantation for adenomatosis: European experience. Liver Transplant 2016; 22: 516-526 doi:10.1002/lt.24417
• 46 Prodromidou A, Machairas N, Garoufalia Z. et al. Liver Transplantation for giant hepatic hemangioma: a systematic review. Transplant Proc 2019; 51: 440-442 doi:10.1016/j.transproceed.2019.01.018