Management of focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA), is multidisciplinary and subject to practice variation. We aimed to evaluate variation in clinical management of FNH and HCA in Europe.
We distributed an online survey (November 2021-March 2022) among 294 European experts. The survey included questions on local practice and included eight clinical vignettes. The clinical vignettes focused on FNH or HCA management in the setting of sex, lifestyle modification, and pregnancy.
The response rate was 32% and respondents included surgeons (38%), gastroenterologists/hepatologists (25%), radiologists (32%), and pathologists (1.6%) from ten European countries. We observed practice variation with regard to lifestyle modification and imaging follow-up in patients with FNH, and with regard to the management of HCA >5 cm before and during pregnancy. Finally, the management of HCA >5 cm after lifestyle modification deviated from EASL guideline recommendations.
Our survey illustrates variability in FNH and HCA management in Europe. Several areas were identified for future research and guideline recommendations, including FNH follow-up and the management of HCA >5 cm. We propose the organization of Delphi consensus meetings to prioritize areas of research and update current guidelines to optimize management for all patients with benign liver tumors.

Hepatic adenomas are rare, benign liver masses of rising incidence in the United States. We present a report of a 22-year-old asymptomatic female with a massive (14.2 × 11.4 cm), centrally located hepatic adenoma. The unique presentation of the adenoma in close proximity to the hepatic vasculature meant the patient was not a candidate for surgical resection. An arterial embolization was used as an alternative approach to initial treatment. Arterial branches supplying the adenoma were identified via computed tomography and embolized with embospheres and coils. The treatment resulted in a large reduction in size and density of the adenoma identified at a 1-month follow-up. The case supports further use of arterial embolization as an initial treatment for large adenomas to improve the outcome of subsequent surgical approaches.