Hepatic adenoma and concurrent focal nodular hyperplasia

Case contributed by Dr Natalie Yang

Presentation

Right upper quadrant pain, ultrasound (performed outside) showed a "liver lesion". For further characterisation.

Patient Data

Age: 30-35 years
Gender: Female

Selected images from liver MRI show a large, subtle T2 hyperintense, well defined rounded lesion in the liver which demonstrates homogenous signal loss on T1 opposed phase scans. Postcontrast images, there is prompt arterial enhancement and lesional washout on portal venous phase, although at least some of that signal loss is due to fat saturation. Incidental lesion lateral to the main one is seen, best appreciated on the arterial phase. 

Case Discussion

Although hepatic adenoma can sometimes "washout", this is atypical and raises concern that the lesion represents a hepatocellular carcinoma. In this instance, however, the reduced signal resulting in a washed-out appearance is at least partly due to the image is "fat saturated" and this lesion loses a lot of signal on the T1 out-of-phase sequence.

In any case, because of the atypical appearances the lesion was resected and was histopathology proven hepatic adenoma. The second lesion, posterolateral to the adenoma, is consistent with an incidental FNH and was not resected. 

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Case information

rID: 6953
Published: 30th Aug 2009
Last edited: 9th Oct 2018
Tag: liver
Inclusion in quiz mode: Included

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