**Thanks**

*Liver Disease and Surgery*

trimester.

[28, 82, 83].

liver [84].

**8. Conclusions**

**7.6 Follow-up of the patients**

disappear more rapidly.

ued but at longer intervals.

Adenomas greater than 5 cm that are discovered during pregnancy need individualized approach. Surgery is recommended during second trimester to minimalize the risks for both the mother and the fetus. Radiofrequency has been an option performed during the first and second trimester [18]. Angioembolization poses the radiation risk to the fetus early in pregnancy and must be avoided in the first

Pregnancy induces not only an increased level of endogenous hormones but also an increased liver vascularity that puts the patient at risk for adenoma rupture especially in the third trimester [81]. However, a ruptured HA discovered during pregnancy should be immediately resected by laparotomy or laparoscopy

The great majority of nonresected uncomplicated HA remains stable, in few cases disappear, and in general do not grow. There is an observation that IHA may

The follow-up of the patients with H-HA and IHA with complete resection can be stopped few years after surgery. In case of incomplete resection and with no significant change in HA size during the first years, the follow-up must be contin-

Instead, the patients with β-HA resected or RF ablated must be followed-up very closely with AFP serum level check and repeated alternating imaging (US, CEUS, CT, and MRI) in order to early diagnose a possible recurrence and, in a much worse scenario, a possible malignancy with the same positioning in the

The incidence of hepatic adenoma has increased lately as a result of more frequent imaging investigations performed for reasons not necessarily related to the presence of this benign tumor. The classical profile of the patient with adenoma has changed as a result of the emergence of new risk factors. As a result of research into phenotype, genotype, and imaging and the correlations of these results with clinical data, it is advisable that the diagnosis of hepatic adenoma include the subgroup of classification, which indicates the appropriate management of the case. The means of fitting the liver adenoma into the four subgroups are primarily imagistic, of which MRI has an essential role. In the case of insufficient data for the correct and complete diagnosis of hepatic adenoma, tumor biopsy is needed percutaneously or after tumor resection. Management of hepatic adenoma may mean on the one hand careful monitoring to recognize one of the two worrisome complications—hemorrhage and malignancy—and on the other hand, the treatment of the tumor, which may be asymptomatic or symptomatic, uncomplicated or complicated. In the elective cases, surgical resection remains the gold standard with a clear tendency toward laparoscopic approach in specialized centers, but in emergency cases caused by adenoma rupture, interventional arteriography has gained a net advantage over surgery. For rare cases of recurrent or extremely bulky hepatic adenomas, for which surgery is not feasible, but also for cases of liver adenomatosis on certain criteria, liver transplantation from cadaveric or living donor has become a reality. Careful monitoring of post-treatment patients should be continued and adapted according to the therapeutic outcomes

**140**

and histopathology of the hepatic adenoma.

We thank our mentor Prof. Dr. Irinel Popescu, MD, PhD, FACS, for giving us the possibility to use data and iconography of patients that he operated on, in order to complete writing this chapter.
