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Hepatic Adenoma
Justin Ruey Tse, MD; Aya Kamaya, MD, FSRU, FSAR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Hepatocellular adenoma (HCA) or liver cell adenoma
            • Definitions

              • Benign tumor that arises from hepatocytes arranged in cords that occasionally form bile

            IMAGING

            • General Features

              • Ultrasonographic Findings

                • CT Findings

                  • MR Findings

                    • Angiographic Findings

                      • Nuclear Medicine Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Staging, Grading, & Classification

                                • Gross Pathologic & Surgical Features

                                  • Microscopic Features

                                    CLINICAL ISSUES

                                    • Presentation

                                      • Demographics

                                        • Natural History & Prognosis

                                          • Treatment

                                            DIAGNOSTIC CHECKLIST

                                            • Consider

                                              • Image Interpretation Pearls

                                                Selected References

                                                1. Vernuccio F et al: Long-term evolution of hepatocellular adenomas at MRI follow-up. Radiology. 295(2):361-72, 2020
                                                2. Burrowes DP et al: RadioGraphics update: contrast-enhanced US approach to the diagnosis of focal liver masses. Radiographics. 40(4):E16-20, 2020
                                                3. Burrowes DP et al: Contrast-enhanced US approach to the diagnosis of focal liver masses. Radiographics. 37(5):1388-400, 2017
                                                4. Nault JC et al: Molecular classification of hepatocellular adenoma associates with risk factors, bleeding, and malignant transformation. Gastroenterology. 152(4):880-94.e6, 2017
                                                5. European Association for the Study of the Liver (EASL).: EASL Clinical Practice Guidelines on the management of benign liver tumours. J Hepatol. 65(2):386-98, 2016
                                                6. Auer TA et al: Hepatocellular adenomas: is there additional value in using Gd-EOB-enhanced MRI for subtype differentiation? Eur Radiol. 30(6):3497-506, 2020
                                                7. Gaspersz MP et al: Growth of hepatocellular adenoma during pregnancy: a prospective study. J Hepatol. 72(1):119-24, 2020
                                                8. Tse JR et al: Qualitative and quantitative gadoxetic acid-enhanced MR imaging helps subtype hepatocellular adenomas. Radiology. 279(1):118-27, 2016
                                                9. Bröker MEE et al: Performance of contrast-enhanced sonography versus MRI with a liver-specific contrast agent for diagnosis of hepatocellular adenoma and focal nodular hyperplasia. AJR Am J Roentgenol. 214(1):81-9, 2020
                                                10. McInnes MD et al: Focal nodular hyperplasia and hepatocellular adenoma: Accuracy of gadoxetic acid-enhanced MR imaging--a systematic review. Radiology. 277(2):413-23, 2015
                                                11. Kamaya A et al: Hypervascular liver lesions. Semin Ultrasound CT MR. 30(5):387-407, 2009
                                                12. Frulio N et al: Evaluation of liver tumors using acoustic radiation force impulse elastography and correlation with histologic data. J Ultrasound Med. 32(1):121-30, 2013
                                                13. Laumonier H et al: Role of contrast-enhanced sonography in differentiation of subtypes of hepatocellular adenoma: correlation with MRI findings. AJR Am J Roentgenol. 199(2):341-8, 2012
                                                14. Yu H et al: Differentiation of benign from malignant liver masses with acoustic radiation force impulse technique. Ultrasound Q. 27(4):217-23, 2011
                                                15. Zhu XL et al: Contrast-enhanced ultrasound for the diagnosis of hepatic adenoma. J Int Med Res. 39(3):920-8, 2011
                                                16. Piscaglia F et al: Characterization of focal liver lesions with contrast-enhanced ultrasound. Ultrasound Med Biol. 36(4):531-50, 2010
                                                17. von Herbay A et al: Contrast-enhanced ultrasound with SonoVue: differentiation between benign and malignant focal liver lesions in 317 patients. J Clin Ultrasound. 38(1):1-9, 2010
                                                18. Bioulac-Sage P et al: Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience. Hepatology. 50(2):481-9, 2009
                                                19. Ricci P et al: Behavior of hepatocellular adenoma on real-time low-mechanical index contrast-enhanced ultrasonography with a second-generation contrast agent. J Ultrasound Med. 27(12):1719-26, 2008
                                                20. Strobel D et al: Contrast-enhanced ultrasound for the characterization of focal liver lesions--diagnostic accuracy in clinical practice (DEGUM multicenter trial). Ultraschall Med. 29(5):499-505, 2008
                                                21. Bartolotta TV et al: Characterization of benign hepatic tumors arising in fatty liver with SonoVue and pulse inversion US. Abdom Imaging. 32(1):84-91, 2007
                                                22. Bioulac-Sage P et al: Hepatocellular adenoma subtype classification using molecular markers and immunohistochemistry. Hepatology. 46(3):740-8, 2007
                                                23. Kim TK et al: Benign liver masses: imaging with microbubble contrast agents. Ultrasound Q. 22(1):31-9, 2006
                                                24. Monga SP: Hepatic adenomas: presumed innocent until proven to be beta-catenin mutated. Hepatology. 43(3):401-4, 2006
                                                25. Dietrich CF et al: Differentiation of focal nodular hyperplasia and hepatocellular adenoma by contrast-enhanced ultrasound. Br J Radiol. 78(932):704-7, 2005
                                                26. von Herbay A et al: Real-time imaging with the sonographic contrast agent SonoVue: differentiation between benign and malignant hepatic lesions. J Ultrasound Med. 23(12):1557-68, 2004
                                                27. Chen TM et al: Relationship between flash echo gray scale imaging features and pathologic findings in hepatic adenoma. J Ultrasound Med. 21(7):821-4, 2002
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Terminology

                                                  • Imaging

                                                    • Top Differential Diagnoses

                                                      • Clinical Issues

                                                        • Diagnostic Checklist

                                                          TERMINOLOGY

                                                          • Synonyms

                                                            • Hepatocellular adenoma (HCA) or liver cell adenoma
                                                          • Definitions

                                                            • Benign tumor that arises from hepatocytes arranged in cords that occasionally form bile

                                                          IMAGING

                                                          • General Features

                                                            • Ultrasonographic Findings

                                                              • CT Findings

                                                                • MR Findings

                                                                  • Angiographic Findings

                                                                    • Nuclear Medicine Findings

                                                                      • Imaging Recommendations

                                                                        DIFFERENTIAL DIAGNOSIS

                                                                          PATHOLOGY

                                                                          • General Features

                                                                            • Staging, Grading, & Classification

                                                                              • Gross Pathologic & Surgical Features

                                                                                • Microscopic Features

                                                                                  CLINICAL ISSUES

                                                                                  • Presentation

                                                                                    • Demographics

                                                                                      • Natural History & Prognosis

                                                                                        • Treatment

                                                                                          DIAGNOSTIC CHECKLIST

                                                                                          • Consider

                                                                                            • Image Interpretation Pearls

                                                                                              Selected References

                                                                                              1. Vernuccio F et al: Long-term evolution of hepatocellular adenomas at MRI follow-up. Radiology. 295(2):361-72, 2020
                                                                                              2. Burrowes DP et al: RadioGraphics update: contrast-enhanced US approach to the diagnosis of focal liver masses. Radiographics. 40(4):E16-20, 2020
                                                                                              3. Burrowes DP et al: Contrast-enhanced US approach to the diagnosis of focal liver masses. Radiographics. 37(5):1388-400, 2017
                                                                                              4. Nault JC et al: Molecular classification of hepatocellular adenoma associates with risk factors, bleeding, and malignant transformation. Gastroenterology. 152(4):880-94.e6, 2017
                                                                                              5. European Association for the Study of the Liver (EASL).: EASL Clinical Practice Guidelines on the management of benign liver tumours. J Hepatol. 65(2):386-98, 2016
                                                                                              6. Auer TA et al: Hepatocellular adenomas: is there additional value in using Gd-EOB-enhanced MRI for subtype differentiation? Eur Radiol. 30(6):3497-506, 2020
                                                                                              7. Gaspersz MP et al: Growth of hepatocellular adenoma during pregnancy: a prospective study. J Hepatol. 72(1):119-24, 2020
                                                                                              8. Tse JR et al: Qualitative and quantitative gadoxetic acid-enhanced MR imaging helps subtype hepatocellular adenomas. Radiology. 279(1):118-27, 2016
                                                                                              9. Bröker MEE et al: Performance of contrast-enhanced sonography versus MRI with a liver-specific contrast agent for diagnosis of hepatocellular adenoma and focal nodular hyperplasia. AJR Am J Roentgenol. 214(1):81-9, 2020
                                                                                              10. McInnes MD et al: Focal nodular hyperplasia and hepatocellular adenoma: Accuracy of gadoxetic acid-enhanced MR imaging--a systematic review. Radiology. 277(2):413-23, 2015
                                                                                              11. Kamaya A et al: Hypervascular liver lesions. Semin Ultrasound CT MR. 30(5):387-407, 2009
                                                                                              12. Frulio N et al: Evaluation of liver tumors using acoustic radiation force impulse elastography and correlation with histologic data. J Ultrasound Med. 32(1):121-30, 2013
                                                                                              13. Laumonier H et al: Role of contrast-enhanced sonography in differentiation of subtypes of hepatocellular adenoma: correlation with MRI findings. AJR Am J Roentgenol. 199(2):341-8, 2012
                                                                                              14. Yu H et al: Differentiation of benign from malignant liver masses with acoustic radiation force impulse technique. Ultrasound Q. 27(4):217-23, 2011
                                                                                              15. Zhu XL et al: Contrast-enhanced ultrasound for the diagnosis of hepatic adenoma. J Int Med Res. 39(3):920-8, 2011
                                                                                              16. Piscaglia F et al: Characterization of focal liver lesions with contrast-enhanced ultrasound. Ultrasound Med Biol. 36(4):531-50, 2010
                                                                                              17. von Herbay A et al: Contrast-enhanced ultrasound with SonoVue: differentiation between benign and malignant focal liver lesions in 317 patients. J Clin Ultrasound. 38(1):1-9, 2010
                                                                                              18. Bioulac-Sage P et al: Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience. Hepatology. 50(2):481-9, 2009
                                                                                              19. Ricci P et al: Behavior of hepatocellular adenoma on real-time low-mechanical index contrast-enhanced ultrasonography with a second-generation contrast agent. J Ultrasound Med. 27(12):1719-26, 2008
                                                                                              20. Strobel D et al: Contrast-enhanced ultrasound for the characterization of focal liver lesions--diagnostic accuracy in clinical practice (DEGUM multicenter trial). Ultraschall Med. 29(5):499-505, 2008
                                                                                              21. Bartolotta TV et al: Characterization of benign hepatic tumors arising in fatty liver with SonoVue and pulse inversion US. Abdom Imaging. 32(1):84-91, 2007
                                                                                              22. Bioulac-Sage P et al: Hepatocellular adenoma subtype classification using molecular markers and immunohistochemistry. Hepatology. 46(3):740-8, 2007
                                                                                              23. Kim TK et al: Benign liver masses: imaging with microbubble contrast agents. Ultrasound Q. 22(1):31-9, 2006
                                                                                              24. Monga SP: Hepatic adenomas: presumed innocent until proven to be beta-catenin mutated. Hepatology. 43(3):401-4, 2006
                                                                                              25. Dietrich CF et al: Differentiation of focal nodular hyperplasia and hepatocellular adenoma by contrast-enhanced ultrasound. Br J Radiol. 78(932):704-7, 2005
                                                                                              26. von Herbay A et al: Real-time imaging with the sonographic contrast agent SonoVue: differentiation between benign and malignant hepatic lesions. J Ultrasound Med. 23(12):1557-68, 2004
                                                                                              27. Chen TM et al: Relationship between flash echo gray scale imaging features and pathologic findings in hepatic adenoma. J Ultrasound Med. 21(7):821-4, 2002