Inflammatory hepatic adenoma

Inflammatory hepatic adenomas are a genetic and pathological subtype of hepatic adenoma. Their appearance and prognosis is different than other subtypes and has highest incidence of haemorrhage amongst hepatic adenoma subtypes.

Most common subtype of hepatic adenoma (40-50%). Occur most commonly in women with oral contraceptive pill (OCP) usage.

Fever, leucocytosis, elevated CRP, and elevated liver function tests (LFTs) are compatible with an inflammatory hepatic adenoma.

MRI
  • T1: isointense or mildly hyperintense relative to liver
  • T1 C+ (Gd): ​marked arterial enhancement that fades in the portal venous phase and delayed phase
  • IP/OP: no hypointensity on the out-of-phase sequence
  • T2
    • ​usually hyperintense
    • an atoll sign may be seen: peripheral rim of high T2 signal intensity with the center of the lesion appearing isointense to the background liver; this is considered a characteristic sign

Inflammatory hepatic adenomas have a higher risk of bleeding than other subtypes (haemorrhage occurs in ~30% of this subtype). Adenomas larger than 5 cm are also at increased risk of haemorrhage.

If imaging shows a hepatic adenoma shows the inflammatory hepatic adenoma subtype, then patients usually stop OCPs and the lesions regresses.

If it does not regress, then one treatment pathway suggests:

  • ≥5 cm: resection
  • <5 cm: biopsy

Tissue diagnosis then confirms or changes the adenoma subtype. If inflammatory pathologic subtype, then:

  • clinical and imaging follow up of any remaining adenomas until menopause
  • resection or thermal ablation of enlarging adenomas that grow >5 cm

It is also a very small risk that a hepatic adenoma may develop into a hepatocellular carcinoma (HCC).

Hepatobiliary pathology
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Article information

rID: 35196
Section: Pathology
Synonyms or Alternate Spellings:
  • Inflammatory hepatic adenomas
  • Inflammatory hepatocellular adenoma
  • Telangiectatic focal nodular hyperplasia
  • Hepatocellular adenoma - inflammatory type

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