Resection of a Giant Hepatocellular Adenoma Causing Refractory Hypertension, Stroke, Hyperkalemia, Malnutrition and Mesenteric Ischemia

Hepatocellular adenoma is a rare, benign liver neoplasm. Hepatocellular adenomas carry a risk of malignant transformation and spontaneous bleeding, and giant hepatic adenomas can cause additional morbidity by compressing important adjacent structures. Surgical resection is recommended for large adenomas and is curative. We report a case of a 31-year old Hispanic male with a giant 35cm hepatocellular adenoma causing right lung compression/collapse, pulmonary hypertension, mesenteric ischemia, refractory hypertension, and cerebrovascular accident (CVA) due to renal vein compression. Exploratory laparotomy, median sternotomy, left lobectomy, cholecystectomy and hepatico-jejunostomy were performed. The giant adenoma was successfully removed with the resolution of all associated medical problems and a full recovery. Massive liver lesions can be resected safely with adequate exposure and may require median sternotomy. Multiple medical problems due to compression can be completely reversed with resection of these benign but giant lesions. Enucleation of giant adenomas is an acceptable form of treatment for lesions causing multiple symptoms due to compression and leads to a cure in most cases.