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

Hepatocellular adenoma must be differentiated from focal nodular hyperplasia, large regenerative hyperplasia, hepatocellular carcinoma in non cirrhotic patients, fibrolamellar hepatocellular carcinoma, cholangiocarcinoma, primary lymphoma, and metastases on the basis of clinical presentation and MRI findings.

Differentiating Hepatocellular Adenoma from other Diseases

Hepatocellular adenoma must be differentiated from focal nodular hyperplasia, large regenerative hyperplasia, hepatocellular carcinoma in non cirrhotic patients, fibrolamellar hepatocellular carcinoma, cholangiocarcinoma, primary lymphoma, and metastases on the basis of clinical presentation and MRI findings:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][16][17][18][19][20][21][22][13][23][24][25][26][27][28] [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]

Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti-mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram

Disease Clinical Manifestations Diagnosis Comments
Symptoms Signs
Abdominal Pain Fever Rigors and Chills Nausea or Vomiting Jaundice Constipation Diarrhea Weight Loss GI Bleeding Hypotension Guarding Rebound Tenderness Bowel Sounds Lab Findings Imaging
Hepatocellular adenoma RUQ - - - - - - - + + - -
  • Normal
Hepatocellular carcinoma/Metastasis RUQ + − + + + + + + + − +

Other symptoms:

Cholangiocarcinoma RUQ + − + + − − + − − − +
  • Normal
Pancreatic carcinoma MidEpigastric − − + + + − + − − − +
  • Normal

Skin manifestations may include:

Focal nodular hyperplasia Diffuse ± − − ± − − + + − − −
  • Normal
Disease Abdominal Pain Fever Rigors and Chills Nausea or Vomiting Jaundice Constipation Diarrhea Weight Loss GI Bleeding Hypotension Guarding Rebound Tenderness Bowel Sounds Lab Findings Imaging Comments
Gallbladder cancer Midepigastric − − + + − + + − − − −
  • Normal
Liver hemangioma Intermittent RUQ − − + + − − − − − − −
  • Normal
Liver abscess RUQ + − + + − − + − − − −
  • Normal
Cirrhosis RUQ +Bloating + − + + − − + − − − −
  • Normal
Inflammatory lesions RUQ ± − + + − − − − − − −
  • Normal
  • Stigmata of liver disease

References

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  2. ↑ Guo, Le-Hang; Xu, Hui-Xiong (2015). "Contrast-Enhanced Ultrasound in the Diagnosis of Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma: Controversy over the ASSLD Guideline". BioMed Research International. 2015: 1–5. doi:10.1155/2015/349172. ISSN 2314-6133.
  3. ↑ Wilson, Stephanie R.; Kim, Tae Kyoung; Jang, Hyun-Jung; Burns, Peter N. (2007). "Enhancement Patterns of Focal Liver Masses: Discordance Between Contrast-Enhanced Sonography and Contrast-Enhanced CT and MRI". American Journal of Roentgenology. 189 (1): W7–W12. doi:10.2214/AJR.06.1060. ISSN 0361-803X.
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  7. ↑ {{cite
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  15. ↑ . doi:10.1102/1470-7330.2009.0015. Missing or empty |title= (help)
  16. ↑ 16.0 16.1 Jang, Hyun-Jung; Yu, Hojun; Kim, Tae Kyoung (2009). "Imaging of Focal Liver Lesions". Seminars in Roentgenology. 44 (4): 266–282. doi:10.1053/j.ro.2009.05.008. ISSN 0037-198X.
  17. ↑ Bhayana, Deepak; Kim, Tae Kyoung; Jang, Hyun-Jung; Burns, Peter N.; Wilson, Stephanie R. (2010). "Hypervascular Liver Masses on Contrast-Enhanced Ultrasound: The Importance of Washout". American Journal of Roentgenology. 194 (4): 977–983. doi:10.2214/AJR.09.3375. ISSN 0361-803X.
  18. ↑ Tamada T, Ito K, Yamamoto A, Sone T, Kanki A, Tanaka F, Higashi H (2011). "Hepatic hemangiomas: evaluation of enhancement patterns at dynamic MRI with gadoxetate disodium". AJR Am J Roentgenol. 196 (4): 824–30. doi:10.2214/AJR.10.5113. PMID 21427331.
  19. ↑ Heiken, Jay P. (2007). "Distinguishing benign from malignant liver tumours". Cancer Imaging. 7 (Special Issue A): S1–S14. doi:10.1102/1470-7330.2007.9084. ISSN 1470-7330.
  20. ↑ Alturkistany, Samira; Jang, Hyun-Jung; Yu, Hojun; Lee, Kyoung Ho; Kim, Tae Kyoung (2011). "Fading hepatic hemangiomas on multiphasic CT". Abdominal Radiology. 37 (5): 775–780. doi:10.1007/s00261-011-9826-6. ISSN 2366-004X.
  21. ↑ Liu GJ, Lu MD, Xie XY, Xu HX, Xu ZF, Zheng YL, Liang JY, Wang W (2008). "Real-time contrast-enhanced ultrasound imaging of infected focal liver lesions". J Ultrasound Med. 27 (4): 657–66. PMID 18359914.
  22. ↑ Kim, Kyoung Won; Choi, Byung Ihn; Park, Seong Ho; Kim, Ah Young; Koh, Young Hwan; Lee, Hyun Ju; Han, Joon Koo (2004). "Pyogenic hepatic abscesses: distinctive features from hypovascular hepatic malignancies on contrast-enhanced ultrasound with SH U 508A; early experience". Ultrasound in Medicine & Biology. 30 (6): 725–733. doi:10.1016/j.ultrasmedbio.2004.03.006. ISSN 0301-5629.
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  24. ↑ Menias, Christine O.; Surabhi, Venkateswar R.; Prasad, Srinivasa R.; Wang, Hanlin L.; Narra, Vamsi R.; Chintapalli, Kedar N. (2008). "Mimics of Cholangiocarcinoma: Spectrum of Disease". RadioGraphics. 28 (4): 1115–1129. doi:10.1148/rg.284075148. ISSN 0271-5333.
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  26. ↑ Yoon KH, Ha HK, Lee JS, Suh JH, Kim MH, Kim PN, Lee MG, Yun KJ, Choi SC, Nah YH, Kim CG, Won JJ, Auh YH (1999). "Inflammatory pseudotumor of the liver in patients with recurrent pyogenic cholangitis: CT-histopathologic correlation". Radiology. 211 (2): 373–9. doi:10.1148/radiology.211.2.r99ma36373. PMID 10228516.
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  28. ↑ Luigi Grazioli, Lucio Olivetti, Giancarlo Mazza & Maria Pia Bondioni (2013). "MR Imaging of Hepatocellular Adenomas and Differential Diagnosis Dilemma". International journal of hepatology. 2013: 374170. doi:10.1155/2013/374170. PMID 23606972.
  29. ↑ Lucas Maillette de Buy Wenniger, Valeska Terpstra & Ulrich Beuers (2010). "Focal nodular hyperplasia and hepatic adenoma: epidemiology and pathology". Digestive surgery. 27 (1): 24–31. doi:10.1159/000268404. PMID 20357448.
  30. ↑ Christian Grieser, Ingo G. Steffen, Daniel Seehofer, Incken-Birthe Kramme, Robert Uktolseya, Christian Scheurig-Muenkler, Bernd Hamm & Timm Denecke (2013). "Histopathologically confirmed focal nodular hyperplasia of the liver: gadoxetic acid-enhanced MRI characteristics". Magnetic resonance imaging. 31 (5): 755–760. doi:10.1016/j.mri.2012.11.006. PMID 23219272. Unknown parameter |month= ignored (help)
  31. ↑ Shahid M. Hussain, Turkan Terkivatan, Pieter E. Zondervan, Esmee Lanjouw, Sjoerd de Rave, Jan N. M. Ijzermans & Rob A. de Man (2004). "Focal nodular hyperplasia: findings at state-of-the-art MR imaging, US, CT, and pathologic analysis". Radiographics : a review publication of the Radiological Society of North America, Inc. 24 (1): 3–17. doi:10.1148/rg.241035050. PMID 14730031. Unknown parameter |month= ignored (help)
  32. ↑ J. T. Ames, M. P. Federle & K. Chopra (2009). "Distinguishing clinical and imaging features of nodular regenerative hyperplasia and large regenerative nodules of the liver". Clinical radiology. 64 (12): 1190–1195. doi:10.1016/j.crad.2009.07.015. PMID 19913129. Unknown parameter |month= ignored (help)
  33. ↑ Giovanni Morana, Luigi Grazioli, Miles A. Kirchin, Maria Pia Bondioni, Niccolo Faccioli, Alessandro Guarise & Gunther Schneider (2011). "Solid hypervascular liver lesions: accurate identification of true benign lesions on enhanced dynamic and hepatobiliary phase magnetic resonance imaging after gadobenate dimeglumine administration". Investigative radiology. 46 (4): 225–239. doi:10.1097/RLI.0b013e3181feee3a. PMID 21102346. Unknown parameter |month= ignored (help)
  34. ↑ I. R. Wanless (1990). "Micronodular transformation (nodular regenerative hyperplasia) of the liver: a report of 64 cases among 2,500 autopsies and a new classification of benign hepatocellular nodules". Hepatology (Baltimore, Md.). 11 (5): 787–797. PMID 2189821. Unknown parameter |month= ignored (help)
  35. ↑ I. R. Wanless (1996). "Nodular regenerative hyperplasia, dysplasia, and hepatocellular carcinoma". The American journal of gastroenterology. 91 (5): 836–837. PMID 8633567. Unknown parameter |month= ignored (help)
  36. ↑ T. Ichikawa, M. P. Federle, L. Grazioli, J. Madariaga, M. Nalesnik & W. Marsh (1999). "Fibrolamellar hepatocellular carcinoma: imaging and pathologic findings in 31 recent cases". Radiology. 213 (2): 352–361. doi:10.1148/radiology.213.2.r99nv31352. PMID 10551212. Unknown parameter |month= ignored (help)
  37. ↑ Jose Traila Campos, Claude B. Sirlin & Jin-Young Choi (2012). "Focal hepatic lesions in Gd-EOB-DTPA enhanced MRI: the atlas". Insights into imaging. 3 (5): 451–474. doi:10.1007/s13244-012-0179-7. PMID 22700119. Unknown parameter |month= ignored (help)
  38. ↑ Christine Sempoux, Ghalib Jibara, Stephen C. Ward, Cathy Fan, Lihui Qin, Sasan Roayaie, M. Isabel Fiel, Myron Schwartz & Swan N. Thung (2011). "Intrahepatic cholangiocarcinoma: new insights in pathology". Seminars in liver disease. 31 (1): 49–60. doi:10.1055/s-0031-1272839. PMID 21344350. Unknown parameter |month= ignored (help)
  39. ↑ Nathalie Guedj, Pierre Bedossa & Valerie Paradis (2010). "[Pathology of cholangiocarcinoma]". Annales de pathologie. 30 (6): 455–463. doi:10.1016/j.annpat.2010.10.004. PMID 21167432. Unknown parameter |month= ignored (help)
  40. ↑ Y. Maetani, K. Itoh, C. Watanabe, T. Shibata, F. Ametani, H. Yamabe & J. Konishi (2001). "MR imaging of intrahepatic cholangiocarcinoma with pathologic correlation". AJR. American journal of roentgenology. 176 (6): 1499–1507. doi:10.2214/ajr.176.6.1761499. PMID 11373220. Unknown parameter |month= ignored (help)
  41. ↑ Riccardo Manfredi, Brunella Barbaro, Gabriele Masselli, Amorino Vecchioli & Pasquale Marano (2004). "Magnetic resonance imaging of cholangiocarcinoma". Seminars in liver disease. 24 (2): 155–164. doi:10.1055/s-2004-828892. PMID 15192788. Unknown parameter |month= ignored (help)
  42. ↑ P. Soyer, B. Van Beers, C. Grandin, J. Pringot & M. Levesque (1993). "Primary lymphoma of the liver: MR findings". European journal of radiology. 16 (3): 209–212. PMID 8508837. Unknown parameter |month= ignored (help)
  43. ↑ E. S. Zafrani & P. Gaulard (1993). "Primary lymphoma of the liver". Liver. 13 (2): 57–61. PMID 8510487. Unknown parameter |month= ignored (help)
  44. ↑ Saravanan Namasivayam, Diego R. Martin & Sanjay Saini (2007). "Imaging of liver metastases: MRI". Cancer imaging : the official publication of the International Cancer Imaging Society. 7: 2–9. doi:10.1102/1470-7330.2007.0002. PMID 17293303.
  45. ↑ Daichi Hayashi, Jaroslaw N. Tkacz, Stephen Hammond, Brooke C. Devenney-Cakir, Souhil Zaim, Nadia Bouzegaou, Souhila Ounadjela & Ali Guermazi (2011). "Gastroenteropancreatic neuroendocrine tumors: multimodality imaging features with pathological correlation". Japanese journal of radiology. 29 (2): 85–91. doi:10.1007/s11604-010-0522-1. PMID 21359932. Unknown parameter |month= ignored (help)


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