# Hepatocellular adenomas with severe intra-abdominal bleeding, related to an underlying coagulation disorder: a case report

## TL;DR

A 42-year-old woman with multiple liver tumors and a bleeding disorder required complex treatment, highlighting the need for expert care in rare liver tumor cases.

## Contribution

This case report highlights the challenges in managing hepatocellular adenomas with severe bleeding and coagulation disorders, emphasizing the need for centralized expertise.

## Key findings

- The patient required multiple endovascular interventions due to recurrent bleeding from hepatocellular adenomas.
- The patient was diagnosed with antiphospholipid syndrome during follow-up, complicating treatment.
- The case underscores the importance of multidisciplinary care and centralized expertise in managing complex hepatocellular adenoma cases.

## Abstract

Hepatocellular adenoma is a rare benign liver tumor. Typically, hepatocellular adenomas are solitary and are found in young women who use estrogen-containing contraceptives. The occurrence of multiple hepatocellular adenoma has been linked to higher body mass index, and as the prevalence of overweight increases, multiple hepatocellular adenomas are seen more often. An hepatocellular adenoma does not always necessitate treatment, as they can regress under conservative strategies. In incidental cases, an adenoma presents owing to bleeding, which is mostly self-limiting. If it is not, embolization of hepatic involved vessels is indicated.

In this case report, we discuss a 42-year old Caucasian woman with multiple hepatocellular bleeds, treated by multiple endovascular procedures. After the first embolization of an adenoma in the right liver lobe, a second bleed occurred in the left lobe, necessitating additional endovascular intervention. During admittance, treatment was complicated by pulmonary embolism and a pneumonia. During follow-up, our patient was diagnosed with antiphospholipid syndrome.

Hepatocellular adenoma is a rare diagnosis that requires centralized expertise. This particular case illustrates the complexity of treatment strategies for associated intra-abdominal bleeding and possible complications. Although liver adenoma is often an incidental finding, it can also result in significant morbidity. Centralization of treatment leads to expertise in managing complex treatment strategies.

Hepatocellular adenoma is a rare diagnosis with a complex treatment strategy. This strategy depends on symptoms, initial presentation, tumor size, molecular diagnostics, and patient-specific factors.A bleed from a liver adenoma requires a multidisciplinary approach and consultation with, or preferably referral to, an expertise center. Expertise is essential for making the appropriate diagnosis and initiating treatment.Concomitant diagnoses or complications can complicate the treatment of hepatocellular adenomas and require a multidisciplinary approach.

Hepatocellular adenoma is a rare diagnosis with a complex treatment strategy. This strategy depends on symptoms, initial presentation, tumor size, molecular diagnostics, and patient-specific factors.

A bleed from a liver adenoma requires a multidisciplinary approach and consultation with, or preferably referral to, an expertise center. Expertise is essential for making the appropriate diagnosis and initiating treatment.

Concomitant diagnoses or complications can complicate the treatment of hepatocellular adenomas and require a multidisciplinary approach.