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Review
. 2019 May 28;25(20):2442-2449.
doi: 10.3748/wjg.v25.i20.2442.

Hepatocellular Adenoma: An Unsolved Diagnostic Enigma

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Free PMC article
Review

Hepatocellular Adenoma: An Unsolved Diagnostic Enigma

Matteo Renzulli et al. World J Gastroenterol. .
Free PMC article

Abstract

Hepatocellular adenoma (HCA) is a rare benign liver tumour associated with the use of oral contraceptives or other steroid medications which occurs predominantly in young and middle-aged women. Unlike other benign liver tumours, an HCA may be complicated by bleeding and malignant transformation. HCAs have been divided into four subtypes based on molecular and pathological features: hepatocyte nuclear factor 1α-mutated HCA, inflammatory HCA, β-catenin-mutated HCA, and unclassified HCA. β-catenin-mutated HCA has the highest risk of haemorrhage or malignant transformation. In the latest upgrade of the guidelines regarding the management of benign liver tumours published in 2016 by the European Association for the Study of the Liver, magnetic resonance imaging (MRI) was recognized to be superior to all other imaging modalities in detecting HCAs and in being able to subtype HCAs up to 80%, with positive identification of 1α-mutated HCA or inflammatory HCA achievable with > 90% specificity. This review analyzed the imaging features of HCA using MRI with hepato-specific contrast agents, focusing on the limitations in the HCA characterization.

Keywords: Gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic acid; Hepato-specific contrast media; Hepatocellular adenoma; Liver neoplasm; Magnetic resonance imaging.

Conflict of interest statement

Conflict-of-interest statement: No potential conflicts of interest. No financial support.

Figures

Figure 1
Figure 1
Diagnostic challenges in hepatocyte nuclear factor 1A mutated hepatocellular adenoma. A: In a 51-year-old woman, the axial T1 in-phase image shows an isointense lesion in liver segment V; B: With signal dropout in the T1 out-of-phase image; C: Slightly hyperintense in the T2-weighted; D: In diffusion-weighted; E: In the arterial phase images; F: Washout of the contrast media in the portal-venous phase; G: In the delayed phase images; H: Hypointense in the hepatobiliary phase image. According to the current guidelines, this lesion is suggestive for a hepatocellular adenoma inactivated for HNF-1α. However, according to the newer proposed classification of hepatocellular adenoma, it is not possible to exclude an inflammatory hepatocellular adenoma containing fat and, as consequence, even a mixed form of β-catenin activated-inflammatory hepatocellular adenoma, on imaging.
Figure 2
Figure 2
Diagnostic challenges in the imaging classification of hepatocellular adenoma. A: In a 47-year-old woman the axial T1 in-phase; B: Out-of-phase images show an isointense lesion in liver segment V; C: Hyperintense in the T2-weighted; D: In the diffusion-weighted; E: In the arterial phase images; F: Without washout of the contrast media in the portal-venous phase; G: In the delayed phase images; H: Hypointense in the hepatobiliary phase image. According to the current guidelines, this lesion is suggestive for an inflammatory hepatocellular adenoma. However, it is not possible to exclude a mixed form of β-catenin activated-inflammatory hepatocellular adenoma or even a hepatocellular adenoma inactivated for HNF-1α without fatty component.

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