Inflammatory adenoma right hepatic lobe

Case contributed by Dr Chris O'Donnell

Presentation

Incidental finding on CT abdomen for epigastric abdominal pain.

Patient Data

Age: 21-year-old
Gender: Female
CT

Incidental finding on CT

Incidental vascular mass lesion in right hepatic lobe on the background of a very fatty liver (arrow)

MRI

Primovist (hepatocyte-concentrated) MR contrast agent

Markedly fatty liver with substantial loss of signal in the liver on the out of phase sequence as compared with the spleen.  Mass lesion in right hepatic lobe showing peripheral rim of T2 signal with slightly lower signal intensity to the central T2 signal increase.  Arterial phase enhancement with central core of absent enhancement persisting during the delayed phase (so-called atoll sign).

MRI

Follow-up MRI after 6 months

Appearances are unchanged after 6 months (if anything the lesion is slightly smaller)

Case Discussion

There are 4 subtypes of hepatocellular adenoma: inflammatory hepatocellular adenoma, hepatocyte-nuclear-factor-1-alpha (HNF-1alpha-mutated) hepatocellular adenoma, beta-catenin-mutated hepatocellular adenomas and unclassified. 

The most common is the inflammatory subtype and is usually seen in young women with obesity, hepatic steatosis (as in this case), diabetes mellitus and alcohol abuse.  Classic appearance is T2 hyperintensity with delayed, persistent, peripheral contrast enhancement with an hepatocyte agent (Primovist) as in this case.  Differential diagnosis is focal nodular hyperplasia.

PlayAdd to Share

Case information

rID: 43301
Case created: 4th Mar 2016
Last edited: 4th Oct 2016
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.