- Hepatic Adenoma
- Female predominance
- Highly associated with OCP use, steroids, steatosis, and glycogen storage disease
- Can present with hemorrhage in 20%
- Primarily composed of hepatocytes and Kuppfer cells
- Hepatic “adenomatosis” without OCP use
- Malignant degeneration to HCC rare
- “ Recent advances in pathology and cytogenetics have thrown fresh light on the pathogenesis of hepatic adenomas leading to classification of HCAs into 3 distinct subgroups, each with a characteristic epidemiology, histopathology, oncogenesis and imaging findings.”
Hepatocellular Adenomas: Current Update on Genertics, Taxonomy and Management
Shanbhogue A et al.
J Comput Assist Tomogra March/April 2011; Volume 35:2; pp159-166 - Hepatic Adenomas: 3 Subtypes
- Hepatocyte nuclear factor-1α (HNF-1α)-mutated HCAs (HNF-HCAs)
- β- catenin mutations
- Inflammatory HCAs (I-HCAs) due to mutations involving interleukin-6 signal transducer (IL-6) - Hepatic Adenomas: facts
- More common in woman (1.8-1)
- Mean age of 41 years
- Strong relationship between long term oral contraceptive use and hepatic adenoma (usually greater than 2 years)
- Increased risk with anabolic androgen steroid intake as well as metabolic liver disease such as glycogen storage disease, tyrosinemia, staetohepatits and hemochromatosis - Hepatic Adenomas: facts
- Usually solitary
- May be multiple in adenomatosis (>10 lesion in liver)
- Size range 1-20 cm
- Hepatic Adenoma
- Female predominance
- Highly associated with OCP use, steroids, steatosis, and glycogen storage disease
- Can present with hemorrhage in 20%
- Primarily composed of hepatocytes and Kuppfer cells
- Hepatic “adenomatosis” without OCP use
- Malignant degeneration to HCC rare - Hepatic Adenoma
1. Hepatic artery vascular supply
2. Heterogeneously hypervascular on the arterial phase
- Fat
- Hemorrhage
3. Variable appearance on venous and delayed images
4. Often encapsulated on venous and delayed images
5. Can have a central scar
- Hepatic Adenoma: Facts
- Predilection to hemorrhage and rupture
- Usually in young woman
- Risk factors include glycogen storage disease (type I) and oral contraceptives/anabolic corticosteroids
- Usually solitary but may be multiple as in adenomatosis (usually greater than 10)
- Increased incidence of malignant degeneration "Hepatic adenomas occur more frequently and more often are multiple in patients with hepatic steatosis." Multiple Hepatic Adenomas Associated with Liver Steatosis at CT and MRI: A Case-Control Study
Furlan A et al
AJR 2008;191:1430-1435 - Hepatic Adenoma: CT Findings
- Non contrast CT: hypodense or isodense
- Arterial phase: moderate enhancement
- Portal phase CT: lesions enhance similar to surrounding liver
- Delayed phase CT: lesions enhance similar to surrounding liver
- Hepatic Adenoma: CT Findings
- Well defined mass that may contain hemorrhage, necrosis, fat and rarely calcification
- Non contrast CT: hypodense or isodense
- Arterial phase: moderate enhancement
- Portal phase CT: lesions enhance similar to surrounding liver
- Delayed phase CT: lesions enhance similar to surrounding liver
- Hepatic Adenoma: Facts
- Majority are solitary (80%)
- Typically in female patients (90%)
- Predisposing factors include
----Oral contraceptive use
----Anabolic steroid use
----Glycogen storage disease (type IA) "Familiarity with both expected and unexpected imaging appearances of common benign hepatic tumors, less commonly encountered benign hepatic tumors, and iatrogenic abnormalities potentially masquerading as hepatic tumors allows the radiologist to achieve an informed differential diagnosis." Benign Hepatic tumors and Pseudotumors
Anderson SW, Kruskal JB, Kane RA
RadioGraphics 2009; 29:211-229
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