AJR 2004; 182:1520
© American Roentgen Ray Society
Radiologic-Pathologic Conferences of The University of Texas
M. D. Anderson Cancer Center |
Hepatic Adenoma
Silvana C. Faria1,
Revathy B. Iyer1,
Asif Rashid2 and
Gary J. Whitman1
1 Department of Radiology, Division of Diagnostic Imaging, The University of
Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 57, Houston, TX
77030.
2 Department of Pathology, The University of Texas M. D. Anderson Cancer Center,
Houston, TX 77030.
Received September 8, 2003;
accepted after revision October 24, 2003.
Address correspondence to R. B. Iyer
(riyer{at}di.mdacc.tmc.edu).
A24-year-old woman with a history of oral contraceptive use presented with
a palpable mass in the right upper abdomen. CT revealed a large mass with
areas of low attenuation in segment V of the right lobe of the liver
(Fig. 1A). MRI showed a 10-cm
mass with signal intensity similar to that of normal liver on unenhanced
T1-weighted images and heterogeneous signal on T2-weighted images
(Fig. 1B). The patient
underwent a partial hepatic resection. Histopathology examination revealed a
hepatic adenoma with focal areas of hemorrhage
(Fig. 1C).
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Fig. 1A. —24-year-old woman with hepatic adenoma. Axial
contrast-enhanced CT scan obtained during portal venous phase shows large mass
(arrows) with low-attenuation areas in segment V of right lobe of
liver.
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Fig. 1C. —24-year-old woman with hepatic adenoma. Photomicrograph of
histopathology specimen shows tumor cells arranged in hepatic plates
resembling normal hepatocytes with large vessels but lacking portal tracts. (H
and E, x10) Inset photomicrograph shows tumor cells with slightly
pleomorphic nuclei arranged in thickened hepatic plates. (H and E,
x160)
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Hepatic adenomas are benign neoplasms that occur most often in young women
with a history of oral contraceptive use; the annual incidence is 3–4
per 100,000 adults [1].
Occasionally, hepatic adenomas are found in men who use anabolic steroids or
in patients with glycogen storage disease or liver adenomatosis. Most patients
with hepatic adenomas are clinically asymptomatic and have normal liver
function. Large adenomas may cause pain in the right upper abdomen. Patients
may present with acute abdominal pain and hypotension related to hemorrhage
into the tumor or rupture of the tumor into the peritoneal cavity
[2].
At histopathology examination, hepatic adenomas are well-circumscribed
lesions, frequently with areas of necrosis or hemorrhage. Hepatic adenomas are
solitary in 70–80% of cases. Multiple lesions are frequently observed in
patients with type I glycogen storage disease and liver adenomatosis
[1,
2]. Histologically, hepatic
adenomas are composed of sheets of cells closely resembling normal hepatocytes
that are arranged in plates separated by sinusoids. Kupffer's cells are
occasionally present but usually in lower numbers than in the normal liver
parenchyma. Bile ducts and portal tracts are absent. Hepatic adenomas have an
arterial blood supply and are usually vascularized tumors
[3].
The sonographic appearance of hepatic adenomas is nonspecific; they may
appear as echogenic lesions because of the presence of fat or intratumoral
hemorrhage [2]. On unenhanced
CT scans, hepatic adenomas are usually well-circumscribed lesions that may
display low attenuation because of the presence of fat, old hemorrhage, or
necrosis. In cases of recent hemorrhage, the lesions may display high
attenuation. Calcification is present in 5–10% of cases. On CT scans
obtained after IV contrast injection, hepatic adenomas usually show early
homogeneous enhancement during the arterial dominant phase. On portal venous
phase and delayed CT scans, hepatic adenomas exhibit attenuation nearly
identical to that of the normal liver
[4].
Although the MRI appearance of hepatic adenomas varies, most are
hyperintense relative to normal liver on T1- and T2-weighted images.
Hyperintensity on T1-weighted images is generally due to the presence of fat
or hemorrhage. A complete or partial capsule presenting as a rim of low signal
intensity may be seen in 25% of cases
[2]. On T2-weighted images,
hepatic adenomas are predominantly hyperintense relative to liver, and they
can be heterogeneous as a result of hemorrhage or necrosis. On dynamic
gadolinium-enhanced gradient-echo MR images, adenomas show early arterial
enhancement and become nearly isointense relative to liver on delayed
images.
The size of some hepatic adenomas remains stable, whereas other adenomas
slowly but progressively enlarge and still others regress after intake of
exogenous estrogen has been discontinued
[2]. Some clinicians favor
nonsurgical management, preferring to observe the tumors after the patient has
discontinued use of estrogen. Others recommend surgical excision because of
concerns of associated malignant transformation and risk of rupture
[3].
References
- Reddy KR, Schiff ER. Approach to a liver mass. Semin
Liver Dis 1993;13:423
–435[Medline]
- Grazioli L, Federle MP, Brancatelli G, Ichikawa T, Olivetti L,
Blachar A. Hepatic adenomas: imaging and pathologic findings.
RadioGraphics2001; 21:877
–894[Abstract/Free Full Text]
- Molina EG. Benign solid lesions of the liver. In: Schiff ER,
Sorrell MF, Maddrey WC, eds. Schiff's diseases of the
liver. Philadelphia, PA: Lippincott, Williams & Wilkins,2003
: 1353–1375
- Ichikawa T, Federle MP, Grazioli L, Nalesnik M. Hepatocellular
adenoma: multiphasic CT and histopathologic findings in 25 patients.
Radiology2000; 214:861
–868[Abstract/Free Full Text]
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