Case list for Adenoma

Multiphase CT reveals multiple hepatic adenomas that are subtly heterogeneously hypervascular without washout. No evidence of cirrhosis, but steatosis. Core biopsy of a smaller mass suggested hepatic adenoma, less likely well-differentiated hepatocellular carcinoma. After discontinuing OCP's, the masses decreased in size over 7 years of follow up (see MR).

The last image shows a small cavernous hemangioma in segment 7. Hemangiomas commonly coexist with hepatic adenomas.

CT shows a large exophytic hepatic adenoma in the left lobe, with foci of fat on the unenhanced image and only mild arterial hypervascularity. Note the large vessel supplying this tumor on arterial phase. There is some washout on the equilibrium phase when compared to the other contrast phases. Note that enhancement of the tumor appears weak throughout all contrast phases, largely because of the dominant fatty components causing low attenuation of the mass. 

Multiphase CT shows a typical hypervascular hepatic adenoma in a fatty liver. Note that the mass is hyperdense even on the unenhanced, portal venous and equilibrium phase with respect to the hypodense fatty liver parenchyma. On the background of non-steatotic liver parenchyma adenomas are often isodense and difficult to see on these three phases.

Cirrhotic liver of unknown etiology.

Hypovascular appearing round mass in the right lobe (arrow) with somewhat nodular peripheral intralesional enhancing portions. Note that the enhancement does not follow blood pool density on arterial and venous phase like cavernous hemangiomas typically do, but only on equilibrium phase. Ultrasound guided biopsy of this lesion revealed telangiectatic adenoma.

Another rounded lesion in segment 5/6 had fatty components with more central progressive enhancement and was biopsy proven focal fat and not an adenoma.

Small subcapsular typical cavernous hemangioma (arrowhead).

Zonal perfusion anomaly in the right hepatic lobe due to portal venous cavernous transformation from remote portal vein thrombosis (shown here). 

Portal vein thrombosis can alter the enhancement pattern of focal masses, resulting in atypical appearances difficult to diagnose.

Three phase CT shows small FNH like mass in segment 6. Lesion has a slightly lobulated contour, which is typical, but not specific for FNH. Prolonged appearing contrast enhancement however is relative due to surrounding steatotic parenchyma; fatty liver precludes sufficient visual assessment of dynamic contrast enhancement. Lesion should not be misinterpreted as hemangioma, since enhancement does not follow blood pool enhancement. No scar identified. Biopsy revealed teleangiectatic (inflammatory) variant of adenoma.