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World J Gastroenterol. May 28, 2019; 25(20): 2442-2449
Published online May 28, 2019. doi: 10.3748/wjg.v25.i20.2442
Hepatocellular adenoma: An unsolved diagnostic enigma
Matteo Renzulli, Alfredo Clemente, Francesco Tovoli, Salvatore Cappabianca, Luigi Bolondi, Rita Golfieri
Matteo Renzulli, Rita Golfieri, Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant’Orsola Hospital, University of Bologna, Bologna 40138, Italy
Alfredo Clemente, Salvatore Cappabianca, Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples 80138, Italy
Francesco Tovoli, Luigi Bolondi, Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna 40138, Italy
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Luigi Bolondi, MD, Doctor, Full Professor, Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Via Albertoni 15, Bologna 40138, Italy. luigi.bolondi@unibo.it
Telephone: +39-0512142958 Fax: +39-0512142699
Received: February 26, 2019
Peer-review started: February 27, 2019
First decision: March 27, 2019
Revised: March 30, 2019
Accepted: April 19, 2019
Article in press: April 20, 2019
Published online: May 28, 2019
Processing time: 91 Days and 10.9 Hours
Abstract

Hepatocellular adenoma (HCA) is a rare benign liver tumour associated with the use of oral contraceptives or other steroid medications which occurs predominantly in young and middle-aged women. Unlike other benign liver tumours, an HCA may be complicated by bleeding and malignant transformation. HCAs have been divided into four subtypes based on molecular and pathological features: hepatocyte nuclear factor 1α-mutated HCA, inflammatory HCA, β-catenin-mutated HCA, and unclassified HCA. β-catenin-mutated HCA has the highest risk of haemorrhage or malignant transformation. In the latest upgrade of the guidelines regarding the management of benign liver tumours published in 2016 by the European Association for the Study of the Liver, magnetic resonance imaging (MRI) was recognized to be superior to all other imaging modalities in detecting HCAs and in being able to subtype HCAs up to 80%, with positive identification of 1α-mutated HCA or inflammatory HCA achievable with > 90% specificity. This review analyzed the imaging features of HCA using MRI with hepato-specific contrast agents, focusing on the limitations in the HCA characterization.

Keywords: Hepatocellular adenoma; Magnetic resonance imaging; Hepato-specific contrast media; Liver neoplasm; Gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic acid

Core tip: In 2017, a group of French Researchers proposed a new classification of hepatocellular adenoma based on genomic analysis, identifying three additional subtypes. However, in this latest paper, the possible imaging features of the aforementioned new subtypes of hepatocellular adenoma were not reported. This review analyzed the imaging features of hepatocellular adenoma using magnetic resonance imaging with hepato-specific contrast agents, focusing on the limitations of the “old” imaging criteria proposed by the European Association for the Study of the Liver when applied to the new subtypes of adenoma.