Gastrointestinal Imaging

Liver Adenomatosis: Clinical, Histopathologic, and Imaging Findings in 15 Patients

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

MATERIALS AND 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.

CONCLUSION: 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.


  • 1 Rooks JB, Ory HW, Ishak KG, et al. Epidemiology of hepatocellular adenoma: the role of oral contraceptive use. JAMA 1979; 242:644-648.
  • 2 Kerlin P, Davis GL, McGill DB, Weiland LH, Adson MA, Sheedy PF. Hepatic adenoma and focal nodular hyperplasia: clinical, pathologic and radiologic features. Gastroenterology 1983; 84:994-1002.
  • 3 Leese T, Farges O, Bismuth H. Liver cell adenomas: a 12-year surgical experience from a specialist hepato-biliary unit. Ann Surg 1988; 208:558-564.
  • 4 Sale GE, Lerner KG. Multiple tumors after androgen therapy. Arch Pathol Lab Med 1977; 101:600-603.
  • 5 Howell RR, Stevenson RE, Ben Menachem Y, Phyliky RL, Berry DH. Hepatic adenomata with type 1 glycogen storage disease. JAMA 1976; 236:1481-1484.
  • 6 Arrive L, Fejou JF, Vilgrain V, et al. Hepatic adenoma: MR findings in 51 pathologically proved lesions. Radiology 1994; 193:507-512.
  • 7 Paulson EK, McClellan JS, Washington K, Spritzer CE, Meyers WC, Baker ME. Hepatic adenoma: MR characteristics and correlation with pathologic findings. AJR Am J Roentgenol 1994; 163:113-116.
  • 8 Chung KY, Mayo Smith WW, Saini S, Rahmouni A, Golli M, Mathieu D. Hepatocellular adenoma: MR imaging features with pathologic correlation. AJR Am J Roentgenol 1995; 165:303-308.
  • 9 Ichikawa T, Federle MP, Grazioli L, Nalesnick M. Hepatocellular adenoma: multiphasic CT and histopathologic findings in 25 patients. Radiology 2000; 214:861-868.
  • 10 Monaco AP, Halgrimsson J, McDermott VW. Multiple adenoma (hamartoma) of the liver treated by subtotal (90%) resection: morphological and functional studies of regeneration. Ann Surg 1964; 159:513-519.
  • 11 Bisson A, Duron JJ, Fagniez PL, Pinadeau Y, Germain A. Adenomatose hepatique et contraceptifs oraux: aspects chirurgicaux. Nouv Presse Med 1974; 3:2079-2082.
  • 12 Lui AFK, Hiratzka LF, Hirose FM. Multiple adenomas of the liver. Cancer 1980; 45:1001-1004.
  • 13 Chen KTK, Bocian JJ. Multiple hepatic adenomas. Arch Pathol Lab Med 1983; 107:274-275.
  • 14 Flejou JF, Barge J, Menu Y, et al. Liver adenomatosis: an entity distinct from liver adenoma?. Gastroenterology 1985; 83:1132-1138.
  • 15 Ribeiro A, Burgart LJ, Nagorney DM, Gores GJ. Management of liver adenomatosis: results with a conservative surgical approach. Liver Transplant Surg 1998; 4:388-398.
  • 16 Choi BI, Han JK, Kim SH, Han MC. MR findings in liver adenomatosis. Gastrointest Radiol 1991; 16:234-236.
  • 17 Khan SS, Fink M, King S. Case report: liver adenomatosis presenting as multiple calcified masses. Clin Radiol 1992; 45:206-207.
  • 18 Friedman LS, Gang DL, Hedberg SE, Isselbacher KJ. Simultaneous occurrence of hepatic adenoma and focal nodular hyperplasia: report of a case and review of the literature. Hepatology 1984; 4:536.
  • 19 Marks WH, Thompson H, Appleman H. Failure of hepatic adenomas (HCA) to regress after discontinuance of oral contraceptives: an association with focal nodular hyperplasia (FNH) and uterine leiomyoma. Ann Surg 1988; 208:190-195.
  • 20 Wanless IR, Mawdsley C, Adams R. On the pathogenesis of focal nodular hyperplasia of the liver. Hepatology 1985; 6:1194-1200.
  • 21 Mathieu D, Zafrani ES, Anglade MC, Dhumeaux D. Association of focal nodular hyperplasia and hepatic hemangioma. Gastroenterology 1989; 97:154-157.
  • 22 Kawakatsu M, Vilgrain VJ, Flejou JF, Nahum H. Association of multiple liver cell adenomas with spontaneous intrahepatic portohepatic shunt. Abdom Imaging 1994; 19:438-440.
  • 23 Arana E, Marti-Bonmati L, Martinez W, Hoyos M, Montes H. Portal vein absence and nodular regenerative hyperplasia of the liver with giant inferior mesenteric vein. Abdom Imaging 1997; 22:506-508.
  • 24 Motoori S, Shinozaki M, Goto N, Kondo F. Case report: congenital absence of the portal vein associated with nodular hyperplasia in the liver. J Gastroenterol Hepatol 1997; 12:639-643.
  • 25 Miller WJ, Dodd , IIIGD, Federle MP, Baron RL. Epithelioid hemangioendothelioma of the liver: imaging findings with pathologic correlation. AJR Am J Roentgenol 1992; 159:53-57.
  • 26 Welch TJ, Sheedy PF, Johnson CM, et al. Focal nodular hyperplasia and hepatic adenoma: comparison of angiography, CT, US and scintigraphy. Radiology 1985; 156:593-595.
  • 27 Choi CS, Freeny PC. Triphasic helical CT of hepatic focal nodular hyperplasia: incidence of atypical findings. AJR Am J Roentgenol 1998; 170:391-395.
  • 28 Oliver JH, Baron RL, Dod JD, et al. Hepatocellular carcinoma: evaluation with biphasic, contrast-enhanced, helical CT. Radiology 1996; 199:505-511.
  • 29 Eckhauser FE, Cheung PS, Vinik AI, Strodel WE, Lloyd RV, Thompson NW. Nonfunctioning malignant neuroendocrine tumors of the pancreas. Surgery 1986; 100:978-988.
  • 30 Oliver JH, Baron RL, Federle MP, Jones BC. Noncontrast and hepatic arterial phase CT imaging in patients with hypervascular liver metastases: is there a significant added value?. Radiology 1997; 205:705-719.

Article History

Published in print: Aug 2000