Spontaneous rupture of benign hepatocellular tumors.

Background: Adenoma and focal nodular hyperplasia (FNH) are rare hepatocellular tumors. Resection of adenoma is recommended because of the risk of malignant change and rupture with hemorrhage, however as FNHs are believed to remain asymptomatic, their resection is not indicated. Aim: To review the pathology of benign hepatocellular tumors presenting with rupture and assess the role of delayed surgical intervention in their management. Methods: Data for patients who presented with benign hepatocellular tumors between January 1995 and October 2002 were obtained. Only patients presenting with spontaneous rupture of tumors were studied. Results: 37 patients with benign hepatocellular tumors (adenoma: 17, FNH: 18, others: 2) were managed during this period. 8 females and 2 males presented with spontaneous rupture of tumors. 6 females were on oral contraceptives (OCP) when they bled. 6 were operated on during the same admission. 3 who remained hemodynamically stable, later underwent elective resection. Surgical resection varied from segmental resection to extended hemi-hepatectomy. There was no post-operative mortality. Surgical resection was facilitated following resolution of sub-capsular haematoma in elective resections. One patient who had multiple lesions in both lobes of liver was considered inoperable and advised to avoid the OCP and has remained well. Histology of the resected lesions showed: adenoma (7), nodular regenerative hyperplasia (1) and FNH (1). Conclusions: Hepatic adenoma is the most common benign hepatocellular turnout to present with spontaneous rupture and bleeding, however FNH may also rupture. There is a role for delayed surgical resection of bleeding tumour in a hemodynamically stable patient. [ABSTRACT FROM AUTHOR]