Hepatic adenoma

Case contributed by Dr Natalie Yang

Presentation

Right upper abdominal pain.

Patient Data

Gender: Female
Modality: Ultrasound

Ultrasound demonstrates of hyperechoic lesion with attenuation of the beam suggesting possible fat content.

Modality: CT

CT demonstrates the lesion contains areas of macroscopic fat, with early arterial enhancement with variable lesional washout on portal venous phase scanning

Fat is demonstrated on CT in 7% of cases; Coarse calcifications seen on CT in 5%; Hyperdense hemorrhage is seen in up to 40%

Modality: MRI

There is signal loss on the T1 opposed phase scans.
The presence of haemorrhage results in variable T1 and T2 signal intensity but will often be high signal as a result.

The T1 fat suppressed images demonstrate that the lesion predominantly loses signal consistent with the fat content; the areas of high T1 signal intensity are consistent with blood product.

Post contrast, the lesion demonstrates prompt arterial enhancement which on delayed phase imaging may fade (ie become iso-intense to liver) or washout - making differentiation with HCC difficult.

Case Discussion

Pathology proven hepatic adenoma.

Hepatic adenomas are benign epithelial neoplasm:

  • most commonly solitary (multiplicity may suggest hepatic adenomatosis)
  • richly vascular tumor which frequently contains hemorrhage and necrosis
  • pseudocapsule derived from compressed/collapsed hepatic parenchyma
  • histological hallmark are clusters of benign hepatocytes arranged in sheets or cords with absent bile ducts
  • Adenomas have variable lipid content ranging from
    • microscopic fat (detected in up to 77% with chemical shift MR) to
    • macroscopic fat (detected at CT in up 7%)

90% of hepatic adenomas occur in women. Associations with

  • oral contraceptive use
  • anabolic steroids
  • glycogen storage disease (Type 1a)
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Case Information

rID: 6951
Case created: 30th Aug 2009
Last edited: 7th Jun 2016
Tag: liver
Inclusion in quiz mode: Included

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