Hepatic adenoma

Difficulties in imaging differentiation of benign liver tumors

Author : Baran Roxana Andreea ; Coordinator : Neagoe Daniela ; Coauthors : Ciofu Marina , Ghita Roxana , Ungureanu Lorena

INTRODUCTION
Hepatic adenoma is a benign hepatic tumor very rarely met in medical practice , much more common among in women than in men . In most cases , a patient with hepatic adenoma has no symptoms.
Benign liver tumors are present in about 10 - 20% of the population . Hemangioma is the most common primary liver tumor , representing approximately 80 % of benign liver tumors . Hamartoma is the second most
common benign liver tumor after hemangioma , and benign hepatic adenoma is rarely met
MATERIAL AND METHODHS CT abdomen and pelvis with contrast substance : Liver - oval formation, well delimited 70.3 / 73 mm , with
nonhomogeneous iodophilia ; presence inside hypodense , noniodophile areas ; it is located in the caudate lobe , it causes
mass effect on the cave vein in the supra - and infrahepatic segments ; spleen – non - homogeneous structure by the presence
Patient of 68 years old , without significant personal pathological
of oval , well - delimited , isodense spontaneous formations with the urge parenchyma , moderately iodophilic, visible both
history , presents at the hospital for low back pain and dysuria , the
during arterial and evenous and late time , with dimensions of 14.7 / 14.9 mm , 11.3 / 11 mm and 8.4 mm respectively.
symptomatology beginning a few days before the presentation.
At the clinical examination the patient with good general Native abdominal IRM and with contrast substance : spleen - the presence of a round - oval area , infracentrimetric , with
condition; pulmonary stetacoustics - bladder murmur present bilaterally, native and postcontrast signal type of hemangiomatous like; space replacement process at the level of the hepatic thread with
without rallies overimposed; rhythmic heart sounds; TA = 140/90 dimensions of 7.4 / 7.1 / 7.1 cm with native heterogeneous structure and postcontrast with the presence of bleeding
mmHg AV = 95 b / min . Mobile abdomen with respiratory movements, inclusions inside , which causes mass effect on the caudate lobe and inferior cave vein apparently without invasion of
without sensitivity to deep palpation; liver and spleen clinically within neighboring structures.
normal limits
RESULTS :

Abdominal ultrasound : Liver, caudate lobe with a non - homogeneous

appearance , diffuse due to presence of a hyperecogenic area , unprecise
delimited , alternating with a well - delimited homogeneous image with
hyperecogenic outline, possibly cavernous hemangioma; image of hepatic
hemangioma with 7.5 mm diameter in hepatic LD; at the splenic level, a
hyperecogenic image with a diameter of 9 mm is highlighted.

Native abdominal IRM and with contrast substance : spleen - the presence of a round - oval area ,
infracentrimetric , with native and postcontrast signal type of hemangiomatous like; space replacement
process at the level of the hepatic thread with dimensions of 7.4 / 7.1 / 7.1 cm with native heterogeneous
structure and postcontrast with the presence of bleeding inclusions inside , which causes mass effect on the
caudate lobe and inferior cave vein apparently without invasion of neighboring structures.

Laboratory explorations showed : normochromic normocytic anemia ( 11,20 g / dl) ;

Low LDH (160 mg / dl). Tumor markers: CEA; αFP; CA19-9 within normal limits.

CONCLUSIONS :

There are benign tumors of large size ,with multiple locations ,but which have any specific
symptoms and are discovered by chance . Presents a general non-specific clinical picture with
and vomiting , which is why many of these tumors are occasionally discovered. epigastric pain
and right hypochondrium , nauses and vomiting , which is why many of these tumors are
occasionally discovered.