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Abdomen » Hepatobiliary
Hepatic Adenoma
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Author(s) :
Danilo Sirigu, MD
 
Presentation A 49 yo woman presents with hx of chronic hepatitis C genotype 1B , grade 6, staging 3 (Ishak) initially diagnosed in 2001. After therapy with pegylated interferon and ribaverin weight based, she achieved a SVR with normal ALT and no evidence of viral replication till now. In December 2007 there was US evidence of hepatic focal lesion of 1,8 cm in S6.
 
 
Caption: Conventional and Contrast Enhanced Ultrasound (CEUS) of liver
Description: Transverse ultrasound image shows a isoechoic focal lesion in the right lobe of the liver. CEUS image at 15 seconds after injection (SonoVue®) shows hypervascular homogeneous enhancement of the mass with hypoechogenicity in portal phase and late phase.
 
 
 
Caption: Conventional and Contrast Enhanced Ultrasound (CEUS) of liver
Description: Transverse ultrasound image shows a isoechoic focal lesion in the right lobe of the liver. CEUS image at 15 seconds after injection (SonoVue®) shows hypervascular homogeneous enhancement of the mass with hypoechogenicity in portal phase and late phase.
 
Differential Diagnosis Hepatocellular carcinoma (HCC, also called malignant hepatoma)
Heaptic Adenoma
 
Final Diagnosis Hepatic Adenoma
 
Discussion Hepatic adenoma is a rare benign tumor of the liver, occurring more frequently in women.
Often related with the use of oral contraceptives, incidence is increased in patients with glycogen
storage disease: type 1 glycogen storage disease (von Gierke); diabetes mellitus, hemochromatosis,
acromegaly, and in males using anabolic steroids.
Approximately 80% of adenomas are solitary and 20% are multiple
Grossly, it appears as a soft, round mass which often contains areas of hemorrhage and necrosis.
Morphologically, the neoplastic cells resemble normal hepatocytes and form plates separated by
sinusoids. Most HA do not contain Kupffer cells. There is a characteristic lack of portal vein tracts and terminal hepatic veins.
Bleeding is a common risk, occurring in about 1/3 of patients with adenomas.
 
Case References
  1. S. C. Faria, R. B. Iyer, A. Rashid, and G. J. Whitman. Hepatic Adenoma. Am. J. Roentgenol., June 1, 2004; 182(6): 1520 - 1520.
  2. Grazioli L, Federle MP, Brancatelli G, Ichikawa T, Olivetti L, Blachar A. Hepatic adenomas: imaging and pathologic findings. RadioGraphics2001; 21:877 –894
  3. P. Ricci, V. Cantisani, M. D'Onofrio, D. Sahani, E. Pagliara, F. Calliada, E. Mehmet, K. Sanjeva, N., Faccioli, R. Pozzi-Mucelli, et al. Behavior of Hepatocellular Adenoma on Real-time Low-Mechanical Index Contrast-Enhanced Ultrasonography With a Second-Generation Contrast Agent. J. Ultrasound Med., December 1, 2008; 27(12): 1719 - 1726.

 
Technical Details
Contrast agent: SonoVue®,  Bracco Diagnostics, Inc.

Case provided courtesy of www.echomovies.it   This site provides a wide range of video cases of excellent quality.
 
 
Follow Up
US guided biopsy of the lesion provided histological diagnosis of hepatic adenoma.
 
 
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