Update: Radiologic-Pathologic Correlation of Hepatocellular Adenoma

Sadhna Dhingra MD, FCAP; Chakradhar Thupili, MD; Steven Chua, MD, PhD; Kaustubh Shirlakar MD; Srinivasa R Prasad, MD; Venkateswar R Surabhi, MD

Disclosures

Appl Radiol. 2019;48(6):21-29. 

In This Article

Pathology

Gross Evaluation

Hepatocellular adenomas are well-demarcated lesions that can occasionally be encapsulated and range in size from 1–30 cm.[8] HA may present as a solitary mass or as multifocal, variably sized, soft tissue masses. They typically arise in non-fibrotic liver, however, they may occur in the background of cirrhosis. HAs reported in the setting of cirrhosis are usually of the inflammatory subtype.[24–26] Rare cases of multiple HNF-1-α mutated HAs has been reported to occur in the background of congenital hepatocellular fibrosis.[27] The cut surface of HA may be tan-yellow or red-brown depending upon the presence of steatosis or peliosis/hemorrhage/old hemorrhage, respectively. Inflammatory HA shows alternating pale red and dark-red surface.[8]

Microscopic Evaluation. Hepatocellular adenoma is classically characterized by sheets of benign-appearing hepatocytes with interspersed thin-walled, unpaired arteries. The hepatocyte trabeculae are 1–3 cells thick and the reticulin framework is preserved. Portal tracts containing portal veins or bile ducts are absent. Few randomly distributed pseudo-portal tract areas with thick walled vessels and ductular reaction can be seen in some HAs. Other variable features include steatosis, inflammatory cell infiltrate, sinusoidal dilatation, myxoid changes[28] and presence of pigments such as bile pigment, lipofuscin or Dubin Johnson-like pigment.[29,30]

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