eMedicine Specialties > Radiology > Gastrointestinal

Hepatic Adenoma: Follow-up

Author: Karen Kodsi Garfield, MD, Attending Physician in Body Imaging, Department of Radiology, St Luke's Hospital
Coauthor(s): Sandor Joffe, MD, Section Chief of Abdominal Imaging, Department of Radiology, Beth Israel Medical Center; Stephen A Okon, MD, Consulting Staff, Assistant Professor of Radiology, Department of Radiology, Beth Israel Medical Center
Contributor Information and Disclosures

Updated: Feb 6, 2009

Intervention

As a result of the risk of intraperitoneal hemorrhage and the rare occurrence of malignant transformation to hepatocellular carcinoma (HCC), surgical resection has been advocated in most patients with presumed hepatic adenoma. The risk of significant bleeding from the tumor is as high as 30%. Unfortunately, the exact risk of malignant transformation is unknown. Other physicians have advocated surgical resection only when the tumors are larger than 5 cm or when alpha-fetoprotein levels are elevated, because these 2 findings are associated with a higher risk of malignancy. Surgical resection is also indicated if the patient is symptomatic.

The value of percutaneous fine-needle biopsy for the diagnosis of hepatic adenoma is controversial for 2 reasons: first, histologic studies may lead to misdiagnosis when differentiating hepatic adenoma from focal nodular hyperplasia (FNH); second, a considerable risk of hemorrhage exists when biopsy is performed on these hypervascular tumors. Hepatic adenoma lesions may diminish after oral contraceptives are discontinued; however, discontinuing oral contraceptives does not lower the risk of malignant transformation.

When a definitive diagnosis of FNH can be made using imaging studies, surgery can be avoided and the lesions can be observed safely using radiologic studies. However, if hepatic adenoma or HCC remains in the differential diagnosis, surgery is usually indicated. In patients who are symptomatic, a report by Ibrahim et al demonstrated that surgical resection resulted in postoperative resolution of symptoms in greater than 80% of patients.2

 


More on Hepatic Adenoma

Overview: Hepatic Adenoma
Imaging: Hepatic Adenoma
Follow-up: Hepatic Adenoma
Multimedia: Hepatic Adenoma
References
Further Reading
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References

  1. Micchelli ST, Vivekanandan P, Boitnott JK, et al. Malignant transformation of hepatic adenomas. Mod Pathol. Apr 2008;21(4):491-7. [Medline].

  2. Ibrahim S, Chen CL, Wang SH, et al. Liver resection for benign liver tumors: indications and outcome. Am J Surg. Jan 2007;193(1):5-9. [Medline].

  3. Herman P, Pugliese V, Machado MA, et al. Hepatic adenoma and focal nodular hyperplasia: differential diagnosis and treatment. World J Surg. Mar 2000;24(3):372-6. [Medline].

  4. Kume N, Suga K, Nishigauchi K, Shimizu K, Matsunaga N. Characterization of hepatic adenoma with atypical appearance on CT and MRI by radionuclide imaging. Clin Nucl Med. Dec 1997;22(12):825-31. [Medline].

  5. Ault GT, Wren SM, Ralls PW, Reynolds TB, Stain SC. Selective management of hepatic adenomas. Am Surg. Oct 1996;62(10):825-9. [Medline].

  6. Gyorffy EJ, Bredfeldt JE, Black WC. Transformation of hepatic cell adenoma to hepatocellular carcinoma due to oral contraceptive use. Ann Intern Med. Mar 15 1989;110(6):489-90. [Medline].

  7. Rooks JB, Ory HW, Ishak KG, et al. Epidemiology of hepatocellular adenoma. The role of oral contraceptive use. JAMA. Aug 17 1979;242(7):644-8. [Medline].

  8. Hill MA, Albert T, Zieske A, Levine EA. Successful resection of multifocal hepatic adenoma during pregnancy. South Med J. Mar 1997;90(3):357-61. [Medline].

  9. Veteläinen R, Erdogan D, de Graaf W, ten Kate F, Jansen PL, Gouma DJ, et al. Liver adenomatosis: re-evaluation of aetiology and management. Liver Int. Apr 2008;28(4):499-508. [Medline].

  10. Casillas VJ, Amendola MA, Gascue A, et al. Imaging of nontraumatic hemorrhagic hepatic lesions. Radiographics. Mar-Apr 2000;20(2):367-78. [Medline]. [Full Text].

  11. Welch TJ, Sheedy PF 2nd, Johnson CM, et al. Focal nodular hyperplasia and hepatic adenoma: comparison of angiography, CT, US, and scintigraphy. Radiology. Sep 1985;156(3):593-5. [Medline]. [Full Text].

  12. Weimann A, Ringe B, Klempnauer J, et al. Benign liver tumors: differential diagnosis and indications for surgery. World J Surg. Nov-Dec 1997;21(9):983-90; discussion 990-1. [Medline].

  13. Deneve JL, Pawlik TM, Cunningham S, Clary B, Reddy S, Scoggins CR, et al. Liver Cell Adenoma: A Multicenter Analysis of Risk Factors for Rupture and Malignancy. Ann Surg Oncol. Jan 8 2009;[Medline].

  14. Ahmad I, Iyer A, Marginean CE, Yeh MM, Ferrell L, Qin L, et al. Diagnostic use of cytokeratins, CD34, and neuronal cell adhesion molecule staining in focal nodular hyperplasia and hepatic adenoma. Hum Pathol. Jan 19 2009;[Medline].

  15. Iyer A, Robert ME, Bifulco CB, Salem RR, Jain D. Different cytokeratin and neuronal cell adhesion molecule staining patterns in focal nodular hyperplasia and hepatic adenoma and their significance. Hum Pathol. Sep 2008;39(9):1370-7. [Medline].

  16. Wojtowycz M, ed. Handbook of Interventional Radiology and Angiography. 2nd ed. St Louis, Mo: Mosby-Year Book; 1995:77-83.

  17. Ichikawa T, Federle MP, Grazioli L, Nalesnik M. Hepatocellular adenoma: multiphasic CT and histopathologic findings in 25 patients. Radiology. Mar 2000;214(3):861-8. [Medline]. [Full Text].

  18. Paulson EK, McClellan JS, Washington K, et al. Hepatic adenoma: MR characteristics and correlation with pathologic findings. AJR Am J Roentgenol. Jul 1994;163(1):113-6. [Medline]. [Full Text].

  19. Paley MR, Mergo PJ, Torres GM, Ros PR. Characterization of focal hepatic lesions with ferumoxides-enhanced T2-weighted MR imaging. AJR Am J Roentgenol. Jul 2000;175(1):159-63. [Medline]. [Full Text].

  20. Venkatesh SK, Yin M, Glockner JF, et al. MR elastography of liver tumors: preliminary results. AJR Am J Roentgenol. Jun 2008;190(6):1534-40. [Medline].

  21. Chang SD, Thoeni RF. Effect of T1 shortening on T2-weighted MRI sequences: comparison of hepatic mass conspicuity on images acquired before and after gadolinium enhancement. AJR Am J Roentgenol. May 2008;190(5):1318-23. [Medline].

  22. Giovanoli O, Heim M, Terracciano L, Bongartz G, Ledermann HP. MRI of hepatic adenomatosis: initial observations with gadoxetic acid contrast agent in three patients. AJR Am J Roentgenol. May 2008;190(5):W290-3. [Medline].

  23. Cherqui D, Rahmouni A, Charlotte F, et al. Management of focal nodular hyperplasia and hepatocellular adenoma in young women: a series of 41 patients with clinical, radiological, and pathological correlations. Hepatology. Dec 1995;22(6):1674-81. [Medline].

  24. Rumack CM, Wilson SR, Charboneau JW, eds. Diagnostic Ultrasound. Vol 1. 2nd ed. St Louis, Mo: Mosby-Year Book; 1998:129-30.

  25. Morin SH, Lim AK, Cobbold JF, Taylor-Robinson SD. Use of second generation contrast-enhanced ultrasound in the assessment of focal liver lesions. World J Gastroenterol. Dec 7 2007;13(45):5963-70. [Medline]. [Full Text].

  26. Patel PM, Alibazoglu H, Ali A, Fordham E, LaMonica G. 'False-positive' uptake of FDG in a hepatic adenoma. Clin Nucl Med. Jul 1997;22(7):490-1. [Medline].

  27. Arrivé L, Fléjou JF, Vilgrain V, et al. Hepatic adenoma: MR findings in 51 pathologically proved lesions. Radiology. Nov 1994;193(2):507-12. [Medline]. [Full Text].

  28. Davis LP, McCarroll K. Correlative imaging of the liver and hepatobiliary system. Semin Nucl Med. Jul 1994;24(3):208-18. [Medline].

  29. Dunphy T. Magnetic resonance imaging of focal liver lesions. Appl Radiol. 2001;30(suppl):69-70.

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Keywords

hepatic adenoma, hepatocellular adenoma, liver adenoma, liver tumor, HA, benign liver tumor, benign epithelial tumor of the liver, liver cell adenoma, hepatocellular carcinoma, HCC, focal nodular hyperplasia, FNH, Kupffer cells, Kupffer's cells

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Contributor Information and Disclosures

Author

Karen Kodsi Garfield, MD, Attending Physician in Body Imaging, Department of Radiology, St Luke's Hospital
Karen Kodsi Garfield, MD is a member of the following medical societies: American College of Radiology, American Medical Association, and Radiological Society of North America
Disclosure: Nothing to disclose.

Coauthor(s)

Sandor Joffe, MD, Section Chief of Abdominal Imaging, Department of Radiology, Beth Israel Medical Center
Sandor Joffe, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Stephen A Okon, MD, Consulting Staff, Assistant Professor of Radiology, Department of Radiology, Beth Israel Medical Center
Stephen A Okon, MD is a member of the following medical societies: American Medical Association and American Roentgen Ray Society
Disclosure: Nothing to disclose.

Medical Editor

Neela Lamki, MD, Professor, Department of Radiology, Sultan Qaboos University, Oman; Adjunct Professor, Department of Radiology, Baylor College of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Paul M Silverman, MD, Professor, Chief of Body Imaging, Chair in Diagnostic Imaging, Department of Radiology, University of Texas MD Anderson Cancer Center
Paul M Silverman, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

John Karani, MBBS, FRCR, Consulting Staff, Department of Radiology, King's College Hospital, London
Disclosure: Nothing to disclose.

 
 
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