New Insights in the Management of Hepatocellular Adenoma

Anne J. Klompenhouwer; Robert A. de Man; Marco Dioguardi Burgio; Valerie Vilgrain; Jessica Zucman-Rossi; Jan N. M. Ijzermans


Liver International. 2020;40(7):1529-1537. 

In This Article


With the continuing knowledge of HCA subtypes and their varying biological behaviour, subtype determination is increasingly important. At this moment only H-HCA and I-HCA can be identified reliably based on contrast enhanced MRI. Given the low risk of malignant transformation and the high sensitivity of MRI in correctly diagnosing H-HCA, these lesions may not have to be biopsied. However, when there is doubt about the subtype on contrast-enhanced MRI, a biopsy should be performed in the lesion. Additionally, as I-HCA cannot be differentiated from bex3IHCA or bex7,8IHCA on imaging yet, biopsy may also be performed in case of an I-HCA to determine whether the lesion has an additional exon 3 or exon 7,8 mutation. The value of biopsy to identify HCA subtypes at risk for malignancy or haemorrhage is becoming a pivotal step in the management of this rare disease.