GI Radiology > Liver > Masses > Hepatocellular Adenoma

Hepatic Masses

Hepatocellular Adenoma

  1. Pathogenesis:
  • A benign lesion but can be pre-malignant. Pathologically, it consists of hepatocytes but lacks bile ducts, portal tracts, or Kupffer cells.  Fat and glycogen can accumulate in these hepatocytes and may affect the lesion's appearance on imaging.  Adenoma may have pseudocapsule and central scar.  It can also hemorrhage, thrombose, and necrose.  
  • Most likely seen in young women.
  • Associated with oral contraceptives and steroids.
  • May be seen with pregnancy, may enlarge and has a tendency to bleed.
  1. Radiographic findings:
  • Adenoma has a heterogeneous and variable appearance secondary to fat and hemorrhage. FNH usually has homogeneous enhancement in arterial phase and washes out promptly. This is a characteristic that may help distinguish adenoma from FNH (Baron and Federle, University of Pittsburgh).
  • Noncontrast CT: equal attenuation or lower attenuation with surrounding liver parenchyma if significant amount of fat is present.
  • Contrast CT: no marked enhancement, may see hemorrhage.
  • T1-weighted MRI: heterogeneous, with areas of increased signal from both fat and hemorrhage. On in- and out-of-phase imaging, a decrease in signal on the out-of-phase sequence is seen if the lesion contains fat.
  • T2-weighted MRI: heterogeneous, with areas of increased signal.
  • Nuclear medicine: does not take up sulfur colloid due to absence of Kupffer cells.

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