Differentiation from a high-grade HCC can be difficult, if not impossible. Unfortunately, these features may also be absent in hepatocellular carcinoma, especially if it is well-differentiated. The tendency for these lesions to bleed may be related to their increased vasculature, which is made up of thin-walled, dilated sinusoids carrying blood at arterial pressure. Patients should stop using oral contraceptives or anabolic steroids. This allows for regression in the size of the majority of the tumors.
Complete resolution is atypical.
The risk of malignant transformation remains even after the contraceptive or steroid use has been discontinued. Yearly ultrasound imaging and an assessment of serum AFP levels is a consideration in all patients with HA, especially those with multiple lesions or single lesions greater than 5 cm in diameter who do not undergo surgical resection. Immediate abdominal imaging is required for HA patients who present with new or worsened abdominal pain or signs of hemodynamic instability. Emergency hepatic arteriography with embolization should be considered to control bleeding in high-risk surgical candidates. Due to the increased risk of spontaneous, life-threatening hemorrhage and the possible malignant transformation associated with larger size tumors or in patients with glycogen storage disease, elective surgical resection is considered for all lesions greater than 5 cm in diameter.