Hepatocellular adenoma differential diagnosis: Difference between revisions
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{{CMG}}; {{AE}} {{ZAS}} | {{CMG}}; {{AE}} {{ZAS}} | ||
==Overview== | ==Overview== | ||
The hepatocellular adenoma must be differentiated from focal nodular hyperplasia, large regenerative hyperplasia, hepatocellular carcinoma in non cirrhotic patients and fibrolamellar hepatocellular carcinoma, cholangiocarcinoma, primary lymphoma and metastases on the basis of clinical presentation and MRI findings. | The [[hepatocellular adenoma]] must be [[Differentiate|differentiated]] from [[focal nodular hyperplasia]], large regenerative [[hyperplasia]], [[hepatocellular carcinoma]] in non [[Cirrhosis|cirrhotic]] [[Patient|patients]] and [[fibrolamellar hepatocellular carcinoma]], [[cholangiocarcinoma]], [[Lymphoma|primary lymphoma]] and [[Metastasis|metastases]] on the basis of [[clinical]] presentation and [[Magnetic resonance imaging|MRI]] findings. | ||
==Hepatocellular adenoma differential diagnosis== | ==Hepatocellular adenoma differential diagnosis== | ||
* The hepatocellular adenoma must be differentiated from following conditions.<ref>{{Cite journal | * The [[hepatocellular adenoma]] must be [[Differentiate|differentiated]] from following [[Disease|conditions]].<ref>{{Cite journal | ||
| author = [[Luigi Grazioli]], [[Lucio Olivetti]], [[Giancarlo Mazza]] & [[Maria Pia Bondioni]] | | author = [[Luigi Grazioli]], [[Lucio Olivetti]], [[Giancarlo Mazza]] & [[Maria Pia Bondioni]] | ||
| title = MR Imaging of Hepatocellular Adenomas and Differential Diagnosis Dilemma | | title = MR Imaging of Hepatocellular Adenomas and Differential Diagnosis Dilemma | ||
| Line 17: | Line 17: | ||
| pmid = 23606972 | | pmid = 23606972 | ||
}}</ref> | }}</ref> | ||
* '''Focal nodular hyperplasia'''<ref>{{Cite journal | * '''[[Focal nodular hyperplasia]]'''<ref>{{Cite journal | ||
| author = [[Lucas Maillette de Buy Wenniger]], [[Valeska Terpstra]] & [[Ulrich Beuers]] | | author = [[Lucas Maillette de Buy Wenniger]], [[Valeska Terpstra]] & [[Ulrich Beuers]] | ||
| title = Focal nodular hyperplasia and hepatic adenoma: epidemiology and pathology | | title = Focal nodular hyperplasia and hepatic adenoma: epidemiology and pathology | ||
| Line 51: | Line 51: | ||
| pmid = 14730031 | | pmid = 14730031 | ||
}}</ref> | }}</ref> | ||
** Focal nodular hyperplasia represents a hyperplastic response to localized vascular abnormality, consequently it is not a true benign tumor but a benign congenital hemartomatous malformation. | ** [[Focal nodular hyperplasia]] represents a [[Hyperplasia|hyperplastic]] response to localized [[vascular]] abnormality, consequently it is not a true [[benign tumor]] but a [[benign]] [[Congenital disorder|congenital]] hemartomatous [[malformation]]. | ||
** It is found in the same age group of patients as hepatocellular adenoma, with a history of oral contraception consumption. | ** It is found in the same [[age]] group of [[Patient|patients]] as [[hepatocellular adenoma]], with a history of [[Oral contraceptive|oral contraception consumption]]. | ||
** Pathologically, focal nodular hyperplasia is usually a solitary, subcapsular and nodular homogenous mass. | ** [[Pathology|Pathologically]], [[focal nodular hyperplasia]] is usually a [[solitary]], subcapsular and nodular homogenous [[mass]]. | ||
** Unlike hepatocellular adenoma, hemorrhage and necrosis are exceptional within the lesion. No malignant degeneration of focal nodular hyperplasia has been observed. | ** Unlike [[hepatocellular adenoma]], [[hemorrhage]] and [[necrosis]] are exceptional within the [[lesion]]. No [[malignant]] [[degeneration]] of [[focal nodular hyperplasia]] has been observed. | ||
** On MRI, a typical scar appears as hyperintense or hypointense stellate area, respectively on T2 and T1 weighted images, it is hypointense during arterial and portal venous phases and slightly hyperintense during equilibrium phase. | ** On [[Magnetic resonance imaging|MRI]], a typical [[scar]] appears as hyperintense or hypointense stellate area, respectively on T2 and T1 weighted images, it is hypointense during [[Artery|arterial]] and [[Portal vein|portal venous]] phases and slightly hyperintense during equilibrium phase. | ||
* '''Large regenerative hyperplasia'''<ref>{{Cite journal | * '''Large regenerative [[hyperplasia]]'''<ref>{{Cite journal | ||
| author = [[J. T. Ames]], [[M. P. Federle]] & [[K. Chopra]] | | author = [[J. T. Ames]], [[M. P. Federle]] & [[K. Chopra]] | ||
| title = Distinguishing clinical and imaging features of nodular regenerative hyperplasia and large regenerative nodules of the liver | | title = Distinguishing clinical and imaging features of nodular regenerative hyperplasia and large regenerative nodules of the liver | ||
| Line 99: | Line 99: | ||
| pmid = 8633567 | | pmid = 8633567 | ||
}}</ref> | }}</ref> | ||
** It is an asymptomatic rare condition characterized by diffuse micronodular transformation of hepatic parenchyma, without fibrous septa between nodules. | ** It is an [[asymptomatic]] [[rare]] condition characterized by diffuse micronodular transformation of [[Liver|hepatic]] [[parenchyma]], without fibrous septa between [[Nodule (medicine)|nodules]]. | ||
** On MRI T2 images, it is isointense or slightly hypointense, whereas hepatocellular adenoma is hyperintense. | ** On [[Magnetic resonance imaging|MRI]] T2 images, it is isointense or slightly hypointense, whereas [[hepatocellular adenoma]] is hyperintense. | ||
* '''Hepatocellular carcinoma in non-cirrhotic patients and fibrolamellar hepatocellular carcinoma'''<ref>{{Cite journal | * '''[[Hepatocellular carcinoma]] in non-cirrhotic patients and [[fibrolamellar hepatocellular carcinoma]]'''<ref>{{Cite journal | ||
| author = [[T. Ichikawa]], [[M. P. Federle]], [[L. Grazioli]], [[J. Madariaga]], [[M. Nalesnik]] & [[W. Marsh]] | | author = [[T. Ichikawa]], [[M. P. Federle]], [[L. Grazioli]], [[J. Madariaga]], [[M. Nalesnik]] & [[W. Marsh]] | ||
| title = Fibrolamellar hepatocellular carcinoma: imaging and pathologic findings in 31 recent cases | | title = Fibrolamellar hepatocellular carcinoma: imaging and pathologic findings in 31 recent cases | ||
| Line 124: | Line 124: | ||
| pmid = 22700119 | | pmid = 22700119 | ||
}}</ref> | }}</ref> | ||
** These are rare malignant primary liver tumors that arise in young healthy patients of both sexes. | ** These are [[rare]] [[malignant]] primary [[liver]] [[Tumor|tumors]] that arise in young healthy [[Patient|patients]] of both sexes. | ||
** Signs of malignancy (vascular and biliary invasion) is not present in hepatocellular adenoma. | ** Signs of [[Cancer|malignancy]] ([[vascular]] and [[Bile duct|biliary]] [[invasion]]) is not present in [[hepatocellular adenoma]]. | ||
* '''Cholangiocarcinoma'''<ref>{{Cite journal | * '''[[Cholangiocarcinoma]]'''<ref>{{Cite journal | ||
| author = [[Christine Sempoux]], [[Ghalib Jibara]], [[Stephen C. Ward]], [[Cathy Fan]], [[Lihui Qin]], [[Sasan Roayaie]], [[M. Isabel Fiel]], [[Myron Schwartz]] & [[Swan N. Thung]] | | author = [[Christine Sempoux]], [[Ghalib Jibara]], [[Stephen C. Ward]], [[Cathy Fan]], [[Lihui Qin]], [[Sasan Roayaie]], [[M. Isabel Fiel]], [[Myron Schwartz]] & [[Swan N. Thung]] | ||
| title = Intrahepatic cholangiocarcinoma: new insights in pathology | | title = Intrahepatic cholangiocarcinoma: new insights in pathology | ||
| Line 171: | Line 171: | ||
| pmid = 15192788 | | pmid = 15192788 | ||
}}</ref> | }}</ref> | ||
** It is the primary malignancy arising from bile duct epithelium and is the second most common liver malignancy after hepatocellular carcinoma. | ** It is the primary [[malignancy]] arising from [[bile duct]] [[epithelium]] and is the second most common [[liver]] [[malignancy]] after [[hepatocellular carcinoma]]. | ||
** On MR imaging, the cholangiocarcinoma is either hypointense or isointense relative to the normal liver on T1 weighted MR images but may range from mildly or markedly hyperintense on T2 weighted images. | ** On [[Magnetic resonance imaging|MR imaging]], the [[cholangiocarcinoma]] is either hypointense or isointense relative to the normal [[liver]] on T1 weighted [[Magnetic resonance imaging|MR images]] but may range from mildly or markedly hyperintense on T2 weighted images. | ||
* '''Primary lymphoma'''<ref>{{Cite journal | * '''[[Lymphoma|Primary lymphoma]]'''<ref>{{Cite journal | ||
| author = [[P. Soyer]], [[B. Van Beers]], [[C. Grandin]], [[J. Pringot]] & [[M. Levesque]] | | author = [[P. Soyer]], [[B. Van Beers]], [[C. Grandin]], [[J. Pringot]] & [[M. Levesque]] | ||
| title = Primary lymphoma of the liver: MR findings | | title = Primary lymphoma of the liver: MR findings | ||
| Line 194: | Line 194: | ||
| pmid = 8510487 | | pmid = 8510487 | ||
}}</ref> | }}</ref> | ||
** Primary lymphoma of the liver (confined to liver without involvement of lymph nodes or spleen or bone marrow) is very rare. | ** [[Lymphoma|Primary lymphoma]] of the [[liver]] (confined to [[liver]] without involvement of [[Lymph node|lymph nodes]] or [[spleen]] or [[bone marrow]]) is very [[rare]]. | ||
** Hepatomegaly, presence of hepatic mass or masses and pain in right upper quadrant are most frequent signs and symptoms in primary lymphoma. | ** [[Hepatomegaly]], presence of [[Liver mass|hepatic mass]] or [[Mass|masses]] and [[pain]] in [[right upper quadrant]] are most frequent [[signs]] and [[symptoms]] in [[Lymphoma|primary lymphoma]]. | ||
** On MR imaging, primary lymphoma is generally seen as homogenously/ | ** On [[Magnetic resonance imaging|MR imaging]], [[Lymphoma|primary lymphoma]] is generally seen as [[Homogenous|homogenously]]/[[Heterogeneous|heterogeneously]] hypointense compared to normal [[parenchyma]] on unenhanced T1 weighted images and hyperintense on T2 weighted images. | ||
* '''Metastases'''<ref>{{Cite journal | * '''[[Metastasis|Metastases]]'''<ref>{{Cite journal | ||
| author = [[Saravanan Namasivayam]], [[Diego R. Martin]] & [[Sanjay Saini]] | | author = [[Saravanan Namasivayam]], [[Diego R. Martin]] & [[Sanjay Saini]] | ||
| title = Imaging of liver metastases: MRI | | title = Imaging of liver metastases: MRI | ||
| Line 219: | Line 219: | ||
| pmid = 21359932 | | pmid = 21359932 | ||
}}</ref> | }}</ref> | ||
** Metastases are most common cause of malignant focal liver lesions. | ** [[Metastasis|Metastases]] are most common [[Causality|cause]] of [[malignant]] focal [[liver]] [[Lesion|lesions]]. | ||
** Liver metastases originate predominantly from primary tumors localized in gastrointestinal tract, by hematogenous spread, via portal vein. | ** [[Liver]] [[Metastasis|metastases]] originate predominantly from primary [[Tumor|tumors]] localized in [[gastrointestinal tract]], by hematogenous spread, via [[portal vein]]. | ||
** On unenhanced T1 weighted images, metastases have low signal intensity compared to surrounding parenchyma. | ** On unenhanced T1 weighted images, [[Metastasis|metastases]] have low signal intensity compared to surrounding [[parenchyma]]. | ||
** On T2 sequences, the lesions demonstrate high signal intensity, although the signal is generally lower than that typically observed in hemangiomas. | ** On T2 sequences, the [[Lesion|lesions]] demonstrate high signal intensity, although the signal is generally lower than that typically observed in [[Hemangioma|hemangiomas]]. | ||
==References== | ==References== | ||
Revision as of 15:09, 15 January 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zahir Ali Shaikh, MD[2]
Overview
The hepatocellular adenoma must be differentiated from focal nodular hyperplasia, large regenerative hyperplasia, hepatocellular carcinoma in non cirrhotic patients and fibrolamellar hepatocellular carcinoma, cholangiocarcinoma, primary lymphoma and metastases on the basis of clinical presentation and MRI findings.
Hepatocellular adenoma differential diagnosis
- The hepatocellular adenoma must be differentiated from following conditions.[1]
- Focal nodular hyperplasia[2][3][4]
- Focal nodular hyperplasia represents a hyperplastic response to localized vascular abnormality, consequently it is not a true benign tumor but a benign congenital hemartomatous malformation.
- It is found in the same age group of patients as hepatocellular adenoma, with a history of oral contraception consumption.
- Pathologically, focal nodular hyperplasia is usually a solitary, subcapsular and nodular homogenous mass.
- Unlike hepatocellular adenoma, hemorrhage and necrosis are exceptional within the lesion. No malignant degeneration of focal nodular hyperplasia has been observed.
- On MRI, a typical scar appears as hyperintense or hypointense stellate area, respectively on T2 and T1 weighted images, it is hypointense during arterial and portal venous phases and slightly hyperintense during equilibrium phase.
- Large regenerative hyperplasia[5][6][7][8]
- It is an asymptomatic rare condition characterized by diffuse micronodular transformation of hepatic parenchyma, without fibrous septa between nodules.
- On MRI T2 images, it is isointense or slightly hypointense, whereas hepatocellular adenoma is hyperintense.
- Hepatocellular carcinoma in non-cirrhotic patients and fibrolamellar hepatocellular carcinoma[9][10]
- These are rare malignant primary liver tumors that arise in young healthy patients of both sexes.
- Signs of malignancy (vascular and biliary invasion) is not present in hepatocellular adenoma.
- Cholangiocarcinoma[11][12][13][14]
- It is the primary malignancy arising from bile duct epithelium and is the second most common liver malignancy after hepatocellular carcinoma.
- On MR imaging, the cholangiocarcinoma is either hypointense or isointense relative to the normal liver on T1 weighted MR images but may range from mildly or markedly hyperintense on T2 weighted images.
- Primary lymphoma[15][16]
- Primary lymphoma of the liver (confined to liver without involvement of lymph nodes or spleen or bone marrow) is very rare.
- Hepatomegaly, presence of hepatic mass or masses and pain in right upper quadrant are most frequent signs and symptoms in primary lymphoma.
- On MR imaging, primary lymphoma is generally seen as homogenously/heterogeneously hypointense compared to normal parenchyma on unenhanced T1 weighted images and hyperintense on T2 weighted images.
- Metastases[17][18]
- Metastases are most common cause of malignant focal liver lesions.
- Liver metastases originate predominantly from primary tumors localized in gastrointestinal tract, by hematogenous spread, via portal vein.
- On unenhanced T1 weighted images, metastases have low signal intensity compared to surrounding parenchyma.
- On T2 sequences, the lesions demonstrate high signal intensity, although the signal is generally lower than that typically observed in hemangiomas.
References
- ↑ Luigi Grazioli, Lucio Olivetti, Giancarlo Mazza & Maria Pia Bondioni (2013). "MR Imaging of Hepatocellular Adenomas and Differential Diagnosis Dilemma". International journal of hepatology. 2013: 374170. doi:10.1155/2013/374170. PMID 23606972.
- ↑ Lucas Maillette de Buy Wenniger, Valeska Terpstra & Ulrich Beuers (2010). "Focal nodular hyperplasia and hepatic adenoma: epidemiology and pathology". Digestive surgery. 27 (1): 24–31. doi:10.1159/000268404. PMID 20357448.
- ↑ Christian Grieser, Ingo G. Steffen, Daniel Seehofer, Incken-Birthe Kramme, Robert Uktolseya, Christian Scheurig-Muenkler, Bernd Hamm & Timm Denecke (2013). "Histopathologically confirmed focal nodular hyperplasia of the liver: gadoxetic acid-enhanced MRI characteristics". Magnetic resonance imaging. 31 (5): 755–760. doi:10.1016/j.mri.2012.11.006. PMID 23219272. Unknown parameter
|month=ignored (help) - ↑ Shahid M. Hussain, Turkan Terkivatan, Pieter E. Zondervan, Esmee Lanjouw, Sjoerd de Rave, Jan N. M. Ijzermans & Rob A. de Man (2004). "Focal nodular hyperplasia: findings at state-of-the-art MR imaging, US, CT, and pathologic analysis". Radiographics : a review publication of the Radiological Society of North America, Inc. 24 (1): 3–17. doi:10.1148/rg.241035050. PMID 14730031. Unknown parameter
|month=ignored (help) - ↑ J. T. Ames, M. P. Federle & K. Chopra (2009). "Distinguishing clinical and imaging features of nodular regenerative hyperplasia and large regenerative nodules of the liver". Clinical radiology. 64 (12): 1190–1195. doi:10.1016/j.crad.2009.07.015. PMID 19913129. Unknown parameter
|month=ignored (help) - ↑ Giovanni Morana, Luigi Grazioli, Miles A. Kirchin, Maria Pia Bondioni, Niccolo Faccioli, Alessandro Guarise & Gunther Schneider (2011). "Solid hypervascular liver lesions: accurate identification of true benign lesions on enhanced dynamic and hepatobiliary phase magnetic resonance imaging after gadobenate dimeglumine administration". Investigative radiology. 46 (4): 225–239. doi:10.1097/RLI.0b013e3181feee3a. PMID 21102346. Unknown parameter
|month=ignored (help) - ↑ I. R. Wanless (1990). "Micronodular transformation (nodular regenerative hyperplasia) of the liver: a report of 64 cases among 2,500 autopsies and a new classification of benign hepatocellular nodules". Hepatology (Baltimore, Md.). 11 (5): 787–797. PMID 2189821. Unknown parameter
|month=ignored (help) - ↑ I. R. Wanless (1996). "Nodular regenerative hyperplasia, dysplasia, and hepatocellular carcinoma". The American journal of gastroenterology. 91 (5): 836–837. PMID 8633567. Unknown parameter
|month=ignored (help) - ↑ T. Ichikawa, M. P. Federle, L. Grazioli, J. Madariaga, M. Nalesnik & W. Marsh (1999). "Fibrolamellar hepatocellular carcinoma: imaging and pathologic findings in 31 recent cases". Radiology. 213 (2): 352–361. doi:10.1148/radiology.213.2.r99nv31352. PMID 10551212. Unknown parameter
|month=ignored (help) - ↑ Jose Traila Campos, Claude B. Sirlin & Jin-Young Choi (2012). "Focal hepatic lesions in Gd-EOB-DTPA enhanced MRI: the atlas". Insights into imaging. 3 (5): 451–474. doi:10.1007/s13244-012-0179-7. PMID 22700119. Unknown parameter
|month=ignored (help) - ↑ Christine Sempoux, Ghalib Jibara, Stephen C. Ward, Cathy Fan, Lihui Qin, Sasan Roayaie, M. Isabel Fiel, Myron Schwartz & Swan N. Thung (2011). "Intrahepatic cholangiocarcinoma: new insights in pathology". Seminars in liver disease. 31 (1): 49–60. doi:10.1055/s-0031-1272839. PMID 21344350. Unknown parameter
|month=ignored (help) - ↑ Nathalie Guedj, Pierre Bedossa & Valerie Paradis (2010). "[Pathology of cholangiocarcinoma]". Annales de pathologie. 30 (6): 455–463. doi:10.1016/j.annpat.2010.10.004. PMID 21167432. Unknown parameter
|month=ignored (help) - ↑ Y. Maetani, K. Itoh, C. Watanabe, T. Shibata, F. Ametani, H. Yamabe & J. Konishi (2001). "MR imaging of intrahepatic cholangiocarcinoma with pathologic correlation". AJR. American journal of roentgenology. 176 (6): 1499–1507. doi:10.2214/ajr.176.6.1761499. PMID 11373220. Unknown parameter
|month=ignored (help) - ↑ Riccardo Manfredi, Brunella Barbaro, Gabriele Masselli, Amorino Vecchioli & Pasquale Marano (2004). "Magnetic resonance imaging of cholangiocarcinoma". Seminars in liver disease. 24 (2): 155–164. doi:10.1055/s-2004-828892. PMID 15192788. Unknown parameter
|month=ignored (help) - ↑ P. Soyer, B. Van Beers, C. Grandin, J. Pringot & M. Levesque (1993). "Primary lymphoma of the liver: MR findings". European journal of radiology. 16 (3): 209–212. PMID 8508837. Unknown parameter
|month=ignored (help) - ↑ E. S. Zafrani & P. Gaulard (1993). "Primary lymphoma of the liver". Liver. 13 (2): 57–61. PMID 8510487. Unknown parameter
|month=ignored (help) - ↑ Saravanan Namasivayam, Diego R. Martin & Sanjay Saini (2007). "Imaging of liver metastases: MRI". Cancer imaging : the official publication of the International Cancer Imaging Society. 7: 2–9. doi:10.1102/1470-7330.2007.0002. PMID 17293303.
- ↑ Daichi Hayashi, Jaroslaw N. Tkacz, Stephen Hammond, Brooke C. Devenney-Cakir, Souhil Zaim, Nadia Bouzegaou, Souhila Ounadjela & Ali Guermazi (2011). "Gastroenteropancreatic neuroendocrine tumors: multimodality imaging features with pathological correlation". Japanese journal of radiology. 29 (2): 85–91. doi:10.1007/s11604-010-0522-1. PMID 21359932. Unknown parameter
|month=ignored (help)