Massive hepatic adenoma response to bland embolization: A case study

Abstract

Hepatic adenomas are rare, benign liver masses of rising incidence in the United States. We present a report of a 22-year-old asymptomatic female with a massive (14.2 × 11.4 cm), centrally located hepatic adenoma. The unique presentation of the adenoma in close proximity to the hepatic vasculature meant the patient was not a candidate for surgical resection. An arterial embolization was used as an alternative approach to initial treatment. Arterial branches supplying the adenoma were identified via computed tomography and embolized with embospheres and coils. The treatment resulted in a large reduction in size and density of the adenoma identified at a 1-month follow-up. The case supports further use of arterial embolization as an initial treatment for large adenomas to improve the outcome of subsequent surgical approaches.

Keywords: Arterial embolization; Benign liver lesion; Hepatic adenoma.

Fig. 1

CTA of the abdomen in arterial phase post contrast identifies a centrally located heterogeneously enhancing central hepatic mass later identified as a proven hepatic adenoma by biopsy measuring 14.2 × 11.2 cm. CTA, computed tomography angiography.

Fig. 2

Digital subtraction angiography of the replaced right hepatic artery (A), left hepatic artery (B), and right inferior phrenic artery (C) was used to identify the vascular supply to the HA. The phrenic artery shows a significant vascular supply to the lesion. HA, Hepatic adenomas.

Fig. 3

Magnetic imaging before treatment via embolization (A) and 1 month after treatment (B). Compared to the initial MRI, the post-treatment shows an overall reduction in size of the lesion in addition to a central necrotic core.