Radiological aspects of giant hepatocellular adenoma of the left liver: A case report

Abstract

BACKGROUNDHepatocellular adenoma (HCA) is very rare and has a high misdiagnosis rate through clinical and imaging examinations. We report a case of giant HCA of the left liver in a young woman that was diagnosed by medical imaging and pathology.CASE SUMMARYA 21-year-old woman was admitted to our department for a giant hepatic tumor measuring 22 cm × 20 cm × 10 cm that completely replaced the left hepatic lobe. Her laboratory data only suggested mildly elevated liver function parameters and C-reactive protein levels. A computed tomography (CT) scan showed mixed density in the tumor. Magnetic resonance imaging (MRI) of the tumor revealed a heterogeneous hypointensity on T1-weighed MR images and heterogeneous hyperintensity on T2-weighed MR images. On dynamic contrast CT and MRI scans, the tumor presented marked enhancement and the subcapsular feeding arteries were clearly visible in the arterial phase, with persistent enhancement in the portal and delayed phases. Moreover, the tumor capsule was especially prominent on T1-weighted MR images and showed marked enhancement in the delayed phase. Based on these imaging manifestations, the tumor was initially considered to be an HCA. Subsequently, the tumor was completely resected and pathologically diagnosed as an HCA.CONCLUSIONHCA is an extremely rare hepatic tumor. Preoperative misdiagnoses were common not only due to the absence of special clinical manifestations and laboratory examination findings, but also due to the clinicians’ lack of practical diagnostic experience and vigilance in identifying HCA on medical images. Our case highlights the importance of the combination of contrast-enhanced CT and MRI in the preoperative diagnosis of HCA.

A Case Report on a Giant Hepatic Inflammatory Adenoma in a Young Female That Presented as Spontaneous Intrahepatic Hematoma

“…In contrast, the CT scan of FNH is characterized by uniform enhancement, except in scar tissue [ 14 ]. Additional FNH is a tumor without a capsule or hemorrhagic necrosis in contrast to our case [ 4 ]. So, the mass had a capsule and intrahepatic hematoma and was getting bigger with oral contraceptives, characteristics of an HCA.…”

“…HCA can remain asymptomatic for many years, and the diagnosis of this benign tumor is mainly made by imaging [ 4 ]. In our case, it presented as acute abdominal pain.…”

“…Recent guidelines suggest surgical resection in all sizes of tumors in males [ 3 ]. In females, surgical resection is suggested if the tumor size is over 5 cm [ 4 ]. In our case, except for the intrahepatic hematoma, the patient had surgical indications because of the giant tumor size.…”

“…In our case, except for the intrahepatic hematoma, the patient had surgical indications because of the giant tumor size. For smaller tumor sizes of less than 5 cm in females, conservative management with cessation of contraceptive pills, anabolic steroids, weight loss, and repeated periodic imaging is suggested [ 4 ].…”

“…They are diagnosed usually in women aged 35-40 years old (female/male ratio: 10:1) [ 3 ] and are usually a solitary lesion [ 2 ]. The diagnosis of HCA is challenging as it is usually misdiagnosed through clinical and imaging examinations [ 4 ]. The differential diagnosis between HCA and FNH is challenging even with the most sensitive imaging techniques, so a biopsy is usually the only solution [ 2 ].…”