Hepatocellular adenomasBy mahyarHistory: 34 Y/F with upper abdominal pain, history of OCP consumption, AFP: normal Findings:
:: CT 1 ::NECT: heterogeneous mass, isodense to hypodense
:: CT 2 ::CECT: Arterial phase: heterogeneous mass
:: CT 3 ::CECT: Delayed phase
:: MRI 1 ::FRFSE : Axial MRI
:: Fluoroscopy 1 ::Hepatic DSA: Hypervascular mass Discussion: Best diagnostic clue: Heterogeneous, hypervascular mass with hemorrhage in a young woman. - Location: 1-Subcapsular region of right lobe of liver (75%). 2- Intraparenchymal or pedunculated (10%). - Size: varies, between 6-30 cm, average size: 8-10 cm. - Key concepts: - Rare benign neoplasm. - Second most frequent hepatic tumor in young women after FNH due to use of oral contraceptive, steroids. - Usually single (adenoma), rarely multiple (adenomatosis). CT Findings: - NECT: - Well-defined, spherical mass, isodense to hypodense (due to lipid), hemorrhage: intratumoral, parenchymal or subcapsular. Fat or calcification seen (less often than on MR). - CECT: - Arterial phase: heterogeneous, hyperdense enhancement. - Portal venous phase: less heterogeneous, hyper-, iso-, hypodense to liver. - Delayed phase (10 min): homogeneous, hypodense, enhancement does not persist (due to arteriovenous shunting). - Pseudocapsule: hyperattenuated to liver and adenoma. - Large adenomas more heterogeneous than smaller lesions. MR Findings: - TlW: - Mass: heterogeneous signal intensity, increased signal intensity (due to fat and recent hemorrhage), more evident on MR than CT. - Decreased signal intensity (necrosis, calcification, old hemorrhage). - Rim (fibrous pseudocapsule): hypointense. - T2W: - Mass: heterogeneous signal intensity, increased signal intensity (old hemorrhage/necrosis). - Decreased signal intensity (fat, recent hemorrhage) - Rim (fibrous pseudocapsule): hypointense. - T1 with Gd: - Gadolinium arterial phase: - Mass: heterogeneous enhancement. - Delayed phase: - Pseudocapsule: hyperintense to liver and adenoma. -Superparamagnetic iron oxide (SPIO): - No uptake in adenoma, few cases take up SPIO (due to active Kupffer cells). - Conventional angiographic Findings: - Hypervascular mass with centripetal flow, enlarged hepatic artery with feeders at tumor, periphery (50%), with hypovascular, avascular regions due to hemorrhage and necrosis. -Nuclear Medicine Findings: -Technetium Sulfur Colloid: - Usually "cold" (photopenic): In 80%, uncommonly "warm": In 20%. - HIDA scan: increased activity. - Gallium Scan: no uptake. Imaging Recommendations: -T2W; T1W with dynamic enhanced multiphasic; GRE in - and opposed-phase images. Demographics: - Age: young women of childbearing age group, predominantly in 3rd and 4th decades. - Gender: 98% seen in females (M: F = 1:10), not seen in males unless on anabolic steroids or with glycogen storage disease. -Complications: -Hemorrhage: Intrahepatic or intraperitoneal (40%). -Rupture: Increased risk in pregnancy. -Risk of malignant transformation: wen size is more than 10 cm (in 10%). -Prognosis: 1-Usually good: 2-After discontinuation of oral contraceptives -After surgical resection of large/symptomatic -Poor: 1- Intraperitoneal rupture. 2- Rupture during pregnancy. 3- Adenomatosis (> 10 adenomas). 4- Malignant transformation. Treatment: - Adenoma less than 6 cm: observation and discontinue oral contraceptives. -Adenoma more than 6 cm and near surface: surgical resection. - Pregnancy should be avoided due to increased risk of rupture. Presentation - Most common signs/symptoms. - RUQ pain (40%): Due to hemorrhage. -Asymptomatic (20%). Staging, Grading or Classification Criteria: - Type I: Estrogen associated HCA. - Type II: Spontaneous HCA in women. - Type III: Spontaneous HCA in men. - Type IV: Spontaneous HCA in children. - Type V: Metabolic disease associated HCA. -Typical hepatocellular adenoma (HCA). - Anabolic steroid-associated HCA. - Multiple hepatocellular adenomas (adenomatosis). Top Differential Diagnoses: - Hepatocellular carcinoma (HCC). -Fibrolamellar hepatocellular carcinoma. - Focal nodular hyperplasia (FNH). - Hypervascular metastases. Differential diagnosis: Top Differential Diagnoses: - Hepatocellular carcinoma (HCC). -Fibrolamellar hepatocellular carcinoma. - Focal nodular hyperplasia (FNH). - Hypervascular metastases. Diagnosis confirmation: Surgery / Histo Category: Gastrointestinal Region / Organ: Abdomen-Liver Etiology: neoplastic References: Diagnostic imaging. Abdomen / Michael P. Federle ... let al.].- 1st ed. Get more for Hepatocellular adenomas Peer-reviewed resources Literature  More publications about Hepatocellular adenomas Challenge yourself with the case quiz! |