Hepatic Adenoma

Snapshot

A 22-year-old woman presents to the emergency department for worsening right upper quadrant abdominal pain. She states that her symptoms have slowly progressed since the past 2 days. On physical exam, you note an athletic female with well-developed muscles. Her current medications include only oral contraceptives. Suddenly, the patient’s blood pressure drops to 90/30 mmHg and her pulse is 145/min.

Introduction

Introduction

Symptoms
- abdominal pain
  - may be localized in the epigastrum or in the right upper quadrant
  - sudden, severe abdominal pain with hypotension suggests rupture of the hepatic adenoma into the peritoneum
Physical examination
- abdominal mass
can be seen in ~30% of cases

Imaging

Abdominal ultrasound
- indication
  - typically assesses adenomas of the liver; however, findings are typically nonspecific
- findings
  - large and often a right lobe lesion
  - typically a hyperechoic mass
CT abdomen with and without contrast
- indication
  - another imaging modality to better characterize liver lesions
- findings
  - may have changes consistent with hemorrhage
MRI of the abdomen with and without contrast
- indication
  - another imaging modality to better characterize liver lesions
- findings
may show arterial enhancement

Studies

Histopathology
- gross
  - soft, smooth, tanned masses containing prominent blood vessels
- histology
adenoma cells that contains glycogen and lipids

Differential

Treatment

Lifestyle
- discontinuation of the oral contraceptives or steroids
  - indication
    - in asymptomatic patients
      - some physicians may prefer resection
Surgical
- resection
  - indication
in symptomatic and large adenomas

Complications