Imaging: — 70-80% solitary — Range 1-15 centimeters in size — Multiple lesions common in patients with glycogen storage disease or liver adenomatosis — Hepatic adenomatosis (greater than 9 hepatic adenomas)
Imaging CT: — Well defined mass that can contain hemorrhage, necrosis, fat and rarely calcification — Non contrast: Hypodense or isodense — Arterial phase: Moderate enhancement — Portal phase: Lesions enhance similar to surrounding liver — Delayed phase: Lesions enhance similar to surrounding liver
DDX:
Complications: — Larger lesions are more prone to bleeding and rupture — Benign tumor with potential for malignant transformation into hepatocellular carcinoma
Treatment: Surgical resection if greater than 5 centimeters
Clinical: — Seen in older children and adolescents — Seen in young female with history of oral contraceptive pill use
Radiology Cases of Hepatic Adenoma
Axial T1 MRI of the abdomen (above left) shows an oval heterogeneous lesion near the dome of the liver which is isointense to liver, which on axial T2 MRI (above middle) is hyperintense, and which on axial Out Of Phase MRI (above right) shows central signal drop out consistent with the presence of fat. Axial T1 MRI with hepatospecific contrast in arterial phase (below left) shows avid enhancement in the lesion, which on axial T1 MRI in venous phase (below middle) becomes isointense, and which on the axial T1 MRI in hepatobiliary phase (below right) shows contrast wash out.Axial (above), coronal (below left) and sagittal (below right) CT with contrast of the abdomen in the portal venous phase show a large, oval, thin walled heterogenous solid lesion in the inferior aspect of the right lobe of the liver that has enhancement which is similar to that of the surrounding liver.
