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.
- Focal nodular hyperplasia
- 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
- 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
- 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
- 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.