**7. Management and current guidelines**

The surgeons must be convinced that HA subtypes are important for the management of the patients. From now on, a diagnosis of HA cannot be conceived without group classification. The number and location of HA play a great role in management, but various clinical conditions such as age, sex, etiology, background liver, or comorbidities must be taken into consideration. Other aspects also play a role in decision making, like where the patient lives, the degree of his/ her anxiety, and cost of surveillance. The management of patients with HA must be planned by a complex team formed by surgeons, hepatologists, pathologists, radiologists, gastroenterologist, molecular biologists, and geneticists.

There are no clear guidelines for the management of HA, because the treatment depends on many factors such as HA size, number, localization, gender, age, presence of symptoms, and complications.

In young women treated with contraceptive pills, asymptomatic lesions under 5 cm in diameter should be kept under close observation with CT/CEUS repeated every 6 months [51] and repeated alpha-feto-protein, all the while ceasing to use contraceptive pills [52]. Any modification in imaging suggesting a malignant transformation or an increase in the serum tumor marker should lead to liver resection. There are some authors who advocate resection of adenomas of any size given their risk of malignization and bleeding, if the resection can be performed with acceptable risk. The facts that surgical excision guarantees a definitive diagnosis and long-term cure favor the universal indication of surgery for HA [53].
