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Hepatic Adenoma

 

 

Related narrative: Hepatic Adenoma

Hepatic adenomas are benign proliferations of normal hepatocytes lacking bile ducts and portal triads. They are lighter than the surrounding liver tissue and well encapsulated. They are usually (70%) solitary and have been reported up to 38 cm in size. The blood supply is predominantly peripheral, and the subcapsular arterioles create a centripetal pattern on contrast enhanced CT scanning. On non-enhanced CT and MRI the findings are non-specific unless fat is present, causing a slight hypodensity. They lack Kupffer cells which take up radiocolloid, and hence appear as a focal defect on nuclear imaging. This finding helps differentiate hepatic adenoma from focal nodular hyperplasia (FNH), which often enhance. The lesions appear to be derived from a clone of hepatocytes. Hepatic adenoma has a dramatic female preponderance (4:1) vs. FNH, and has a potential for malignant degeneration.

A strong association with oral contraceptives was noted in the 1970s, with the incidence directly proportional to the duration of use. The lesions appear predominantly in young women (average age 34). About half these lesions are discovered incidentally, the remainder presenting with bleeding, pain or abdominal mass. Bleeding is a common risk, occurring in about 1/3 of patients with adenomas. Women who stop birth control pills and become pregnant are at particular risk. Resection is indicated when hepatic adenoma is diagnosed.

References:

Townsend: Sabiston Textbook of Surgery, 16th ed., Copyright 2001 W. B. Saunders Company, p.1032.

Trotter JF, Everson GT, Benign focal lesions of the liver, Clinics in Liver Disease, Volume 5 o Number 1 o February 2001, Copyright 2001 W. B. Saunders Company


This page was last modified on 11-Mar-2003.