Hepatocellular adenoma differential diagnosis
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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
- 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/heterogenously hypointense compared to normal parenchyma on unenhanced T1 weighted images and hyperintense on T2 weighted images.
- Metastases
- 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)