Hepatic adenoma

Case contributed by Natalie Yang
Diagnosis almost certain

Presentation

Right upper abdominal pain.

Patient Data

Gender: Female

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

ultrasound

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

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%

mri

There is signal loss on the T1 opposed phase scans.

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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