Hepatocellular adenoma differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zahir Ali Shaikh, MD[2]


Hepatocellular adenoma must be differentiated from focal nodular hyperplasia, large regenerative hyperplasia, hepatocellular carcinoma in non cirrhotic patients, fibrolamellar hepatocellular carcinoma, cholangiocarcinoma, primary lymphoma, and metastases on the basis of clinical presentation and MRI findings.

Differentiating Hepatocellular Adenoma from other Diseases

Hepatocellular adenoma must be differentiated from focal nodular hyperplasia, large regenerative hyperplasia, hepatocellular carcinoma in non cirrhotic patients, fibrolamellar hepatocellular carcinoma, cholangiocarcinoma, primary lymphoma, and metastases on the basis of clinical presentation and MRI findings:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][16][17][18][19][20][21][22][13][23][24][25][26][27][28] [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]

Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti-mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram

Disease Clinical Manifestations Diagnosis Comments
Symptoms Signs
Abdominal Pain Fever Rigors and Chills Nausea or Vomiting Jaundice Constipation Diarrhea Weight Loss GI Bleeding Hypotension Guarding Rebound Tenderness Bowel Sounds Lab Findings Imaging
Hepatocellular adenoma RUQ - - - - - - - + + - -
  • Normal
Hepatocellular carcinoma/Metastasis RUQ + + + + + + + + +

Other symptoms:

Cholangiocarcinoma RUQ + + + + +
  • Normal
Pancreatic carcinoma MidEpigastric + + + + +
  • Normal

Skin manifestations may include:

Focal nodular hyperplasia Diffuse ± ± + +
  • Normal
Disease Abdominal Pain Fever Rigors and Chills Nausea or Vomiting Jaundice Constipation Diarrhea Weight Loss GI Bleeding Hypotension Guarding Rebound Tenderness Bowel Sounds Lab Findings Imaging Comments
Gallbladder cancer Midepigastric + + + +
  • Normal
Liver hemangioma Intermittent RUQ + +
  • Normal
Liver abscess RUQ + + + +
  • Normal
Cirrhosis RUQ +Bloating + + + +
  • Normal
Inflammatory lesions RUQ ± + +
  • Normal
  • Stigmata of liver disease


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