Liver adenomatosis: clinical, histopathologic, and imaging findings in 15 patients.
OBJECTIVE
To report and correlate the clinical, histopathologic, and imaging findings in 15 patients with liver adenomatosis.


METHODS
Fifteen adult patients had more than 10 hepatic adenomas each and no history of glycogen storage disease or anabolic steroid use. Ten of them underwent bolus-enhanced dynamic computed tomography (CT) with or without magnetic resonance (MR) imaging, ultrasonography, and/or angiography.


RESULTS
Clinical abnormalities included abdominal pain in 11 (73%) and hepatomegaly in 10 (67%) patients, and abnormal liver function in 10 (91%) of 11 patients. The number of adenomas in each patient was 10-50 at imaging, but many more lesions were found in the resected specimens. Hemorrhage was commonly found within adenomas at histopathologic analysis, but only four patients had clinical and imaging evidence of substantial hemorrhage. In all patients, the adenomas increased over time, and two patients developed hepatocellular carcinoma. CT and MR features of the adenomas included evidence of hypervascularity (63%), intratumoral fat (50% of patients at CT, 80% at MR), and decreased conspicuity at portal venous and delayed-phase imaging. Fifty percent of patients had congenital or acquired hepatic vascular abnormalities.


CONCLUSIONS
The imaging and histopathologic features of individual adenomatous lesions are similar to those reported in young women who are taking oral contraceptives. However, the lesions in liver adenomatosis are not steroid dependent but rather multiple, progressive, and symptomatic, and they are more likely to lead to impaired liver function, hemorrhage, and perhaps malignant degeneration.
Grazioli
L
L
Departments of Radiology, University of Pittsburgh Medical Center, Presbyterian Hospital, 200 Lothrop St, Room 4660 CHP MT, Pittsburgh, PA 15213, USA.
Federle
M P
MP
Ichikawa
T
T
Balzano
E
E
Nalesnik
M
M
Madariaga
J
J
D015746:Abdominal Pain / Q000175:diagnosis; D000236:Adenoma / Q000098:blood supply / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D000273:Adipose Tissue / Q000473:pathology; D000328:Adult; D000368:Aged; D000792:Angiography; D001808:Blood Vessels / Q000002:abnormalities; D006528:Carcinoma, Hepatocellular / Q000473:pathology; D003287:Contrast Media; D003952:Diagnostic Imaging; D018450:Disease Progression; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000175:diagnosis / Q000473:pathology; D006470:Hemorrhage / Q000473:pathology; D006529:Hepatomegaly / Q000175:diagnosis; D006801:Humans; D008099:Liver / Q000098:blood supply / Q000201:enzymology; D008113:Liver Neoplasms / Q000098:blood supply / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000473:pathology; D011169:Portal Vein / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D003287:Contrast Media