1. Frederick C. Cobey, M.D., M.P.H., Ronald R. Salem, M.D. The American Journal of Surgery 187 (2004) 181-191

2. ◦ Literature Review  Medline search from 1966 to 2002  keywords:  Hepatic mass  Pregnancy  Adenoma  Focal nodular hyperplasia  Hemangioma  26 pregnancies with liver cell adenomas were identified ◦ 7 additional illustrative cases of liver masses during pregnancy from the Department of Surgery of The Yale University School of Medicine  1 pregnancy with liver cell adenoma

4.  Aggressive approach to resection of LCA >5 cm should be seriously considered in pregnancy.  Small asymptomatic LCAs (<5 cm) may be observed during the course of pregnancy and may not require immediate surgical intervention  For smaller lesions early in pregnancy an aggressive approach to resections is suggested if an increase of the size is observed

5. Johanna E. Noels, Susanna M. van Aalten, Dirk J. van der Windt, Niels F.M. Kok, Rob A. de Man, Turkan Terkivatan, Jan N.M. Ijzermans Jounal of Hepatology 2010

6.  Between January 2000 and December 2009 The Erasmus Medical Center recorded all data of patients with LCA  Those patients were advised to discontinue the use of oral contraceptive and prevent pregnancy  11 patients got pregnant nevertheless and were closely monitored by ultrasound and/or MR imaging. (In 1 patient LCA was diagnosed during pregnancy)

7.  Presentation before pregnancy: ◦ 4 patients were symptomatic (pain right flank) ◦ 5 patients had unspecific complaints (abdominal pain) ◦ 2 patients were asymptomatic  Adenoma size at time of diagnosis: ◦ 7 patients: <5 cm ◦ 5 patients: >5 cm  These 12 patients were monitored during a total of 17 pregnancies

8.  Growth: ◦ In 4 pregnancies: Growth ◦ In 11 pregnancies: No growth/regression observed ◦ In 1 pregnancy: Minimal regression ◦ In 1 pregnancy: unknown  Interventions during pregnancy: ◦ 3 Cesarian sections, 1 radiofrequency ablation  All pregnancies had an uneventful course with a successful maternal and fetal outcome

9.  Pregnancy may be allowed to women with small tumors (<5 cm). Yet, close monitoring is proposed.  In women who have large tumors or who have experienced complications of LCA in previous pregnancies, a negative advice against pregnancy is justified because of an increased risk of complications. ◦ In that case, surgical resection should be recommended before pregnancy.

10. From: Management of Hepatocellular Adenoma: Recent Advances Shefali Agrawal, Sheela Agarwal, Thomas Arnason, Sanjay Saini, Jacques Belghiti Clinical Gastroenterology and Hepatology 2015;13:1221-1230