Posted on May 20, 2019
Hepatic adenomas are benign epithelial liver lesions. Also known as hepatocellular adenomas (HCAs), a liver adenoma can occur as a single lesion or in multiples.
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Hepatic adenoma liver lesions are rare, found most often in women of childbearing age, particularly 20 - 44 years old. They have an estimated incidence rate of 3 - 4 women per 100,000 women, and are approximately 10 times less prevalent than focal nodular hyperplasia lesions.
There is a strong association between the development of hepatic adenoma lesions and the use of contraceptive pills, estrogen therapy medications, and anabolic steroids. Athletes taking anabolic steroids and women who regularly use oral contraceptive pills should discontinue use immediately following a diagnosis.
Although rare, a hepatic adenoma liver lesion runs the risk of malignant transformation, spontaneous hemorrhage, and rupture. Hepatic adenoma liver lesions can also be difficult to differentiate from other liver lesions, and can be mistaken for liver cancer. Their distinction from other types of benign and malignant liver tumors is critical. This can best be accomplished through radiographic studies, with image interpretation by a subspecialty radiologist who specializes in liver lesion identification.
Because most hepatic adenomas do not cause symptoms, they are usually discovered incidentally during an abdominal ultrasound for an unrelated condition. Once detected, they can be extremely difficult to distinguish from other lesions, especially focal nodular hyperplasia lesions.
A CT or MRI with appropriate contrasting can help differentiate them. Image interpretation should always be by a radiologist with extensive subspecialty expertise in identifying masses of the abdomen.
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Hepatic adenoma lesions are often asymptomatic, although a considerable number of patients experience abdominal discomfort. Large lesions, especially, tend to cause pain in the upper right part of the abdomen.
Many asymptomatic adenomas remain undetected. Detected liver adenomas linked to the use of OCCs may disappear on their own following discontinuation of the drug.
Some hepatic adenoma lesions, however, are at high risk of malignant transformation, spontaneous rupture, and hemorrhage. To prevent further complications, surgical removal may be advised. Spontaneous rupture and hemoperitoneum occur in 10% of cases, especially during menstruation, pregnancy or postpartum. Patients with larger adenomas also have a higher risk of rupture.
Ruptured adenomas require immediate intervention to prevent hemorrhage.
Regular use of contraceptive pills, estrogen therapy medications, and anabolic steroids have been linked to the development and growth of hepatic adenoma lesions.
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Dr. Richard Semelka, leading expert in abdominal imaging, has been practicing radiology for over 28 years. He’s written over 16 text-books, 370 peer-reviewed papers, and has over 21,000 research citations in Abdominal Imaging.