Updated: 8/17/2020

Hepatic Adenoma

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Snapshot
  • A 27-year-old woman presents to the emergency department for worsening right upper quadrant abdominal pain. She states that her symptoms have slowly progressed since yesterday. On physical exam, you note an athletic female with well-developed muscles. Her current medications include only oral contraceptives and she is generally healthy. Suddenly, the patient's blood pressure drops to 90/30 mmHg and her pulse is 145/min.
Introduction
  • Overview
    • benign epithelial tumors arising from the liver
      • typically arising in the right hepatic lobe and are usually solitary masses
        • multiple adenomas can be seen in
          • prolonged contraceptic use
          • glycogen storage disorders
          • hepatic adenomatosis
  • Epidemiology
    • demographic
      • young women
    • risk factors
      • oral contraceptives
      • anabolic androgens
      • glycogen storage disorders type I and III
      • pregnancy
Introduction
  • Symptoms
    • abdominal pain
      • may be localized in the epigastrum or in the right upper quadrant
      • sudden, severe abdominal pain with hypotension suggests rupture of the hepatic adenoma into the peritoneum
  • Physical examination
    • abdominal mass
      • can be seen in ~30% of cases
Imaging
  • Abdominal ultrasound
    • indication
      • typically assesses adenomas of the liver; however, findings are typically nonspecific
    • findings
      • large and often right lobe lesion
      • typically a hyperechoic mass
  • CT abdomen with and without contrast
    • indication
      • another imaging modality to better characterize liver lesions
    • findings
      • may have changes consistent with hemorrhaging
  • MRI of the abdomen with and without contrast
    • indication
      • another imaging modality to better characterize liver lesions
    • findings
      • may show arterial enhancement
Studies
  • Histopathology
    • gross
      • soft, smooth, tanned masses containing prominent blood vessels 
    • histology
      • adenoma cells that contains glycogen and lipids
Differential
  • Hepatocellular carcinoma
    • differentiating factor
      • increased α-fetoprotein
      • hypervascular tumor on CT 
Treatment
  • Lifestyle
    • discontinuation of the oral contraceptives or steroids
      • indication
        • in asymptomatic patients
          • some physicians may prefer resection
  • Surgical
    • resection
      • indication
        • in symptomatic and large adenomas
Complications
  • Malignant transformation
  • Spontaneous rupture and hemorrhage
 

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