JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
hypoenhancement,which ismoreconsistentwithHepatocellular Carcinoma or Hypervascular Metastatic disease.
Treatment of HA is given on a case-by-case basis. Resection is reserved for sympromatic patients with adenomas ≥ 5 cms, high risk features of malignancy on imaging or biopsy and lesions with a size increase of ≥ 1 cm in follow up imaging. Transarterial embolization is indicated in actively hemorrhagic lesions; Radiofrequency ablation may also be considered in order to decrease the size of the lesion. Liver transplantation is an uncommon indication for HA and is reserved for cases with malignant transformation. 6,7 Follow up of HA with CT or MR with contrast and Alpha Feto Protein every six months for two years following diagnosis and yearly thereafter has been suggested by the American College of Gastroenterology guidelines. 6,7
REFERENCES
1. Low G, Dharmana H, Saravana – Bawan S, et al. Case 235: Hepatic Adenomatosis Due to Inflammatory Adenomas. Radiology. 2016;281(2):639-645. 2. Flejou JF, Barge J, Menu Y, et al. Liver adenomatosis. An entity distinct from liver adenoma. Gastroenterology 1985;89(5):1132– 1138. 3. Donato M, Hamidian A, Andrade A, et al. Hepatic Adenomatosis: A Rare but Important Liver Disease With Severe Clinical Implications Int Surg 2015;100:903-907. 4. Chiche L, Dao T, Salame E, et al. Liver adenomatosis: reappraisal, diagnosis, and surgical management. Ann Surg 2000;231(1):74–81. 5. Grazioli L, Federle MP, Brancatelli G, et al. Hepatic adenomas: imaging and pathologic findings. Radiographics 2001;21(4): 877–892. 6. Meyer C, Lisker-Melman M. Treatment of Hepatic Adenomatosis. Curr Hepatol Rep. 2015; 14(2): 139–143. 7. Marrero JA, Ahn J, Rajender Reddy K. ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol. 2014 ; 109(9):1328–1347. Juan Gomez, MD, is a Visiting Neuroradiology Research Fellow. Adam Blanchard, MD, is a third year Radiology Resident at Tulane University, in New Orleans, LA. Mandy Weidenhaft, is a Radiology Program Director at Tulane University, in New Orleans, LA. Jeremy Nguyen is Vice chairman Department of Radiology, Tulane University, in New Orleans, LA. Zahraa Ghandour MD, is a second year Pathology Resident at Tulane Medical Center, in New Orleans, LA. Donald Olivares, is a Technical Assistant, Digital Imaging Specialist and Graphic Designer at Tulane University, New Orleans, LA.
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