Gd-EOB-DTPA-Enhanced magnetic resonance findings of a giant inflammatory hepatocellular adenoma. a case report and review of the literature

Hepatocellular adenoma (HCA) is a rare benign tumour mainly found in women who have been receiving oral contraceptives [1]. According to recent studies, HCAs are currently catego- rized in four distinct genetic and pathologic subtypes as fol- lows: inflammatory HCA, hepatocyte-nuclear-factor-1- alpha-(HNF-1α-mutated) HCA, β-catenin-mutated HCA and Bunclassified^ subtype [2, 3]. Inflammatory HCA is also known as telangiectatic HCA and previously referred to as telangiectatic focal nodular hy- perplasia (FNH) [4, 5]. This particular subtype of HCA has specifically been linked to an increased body mass index and a generalized systemic inflammatory condition [4, 6]. Magnetic resonance imaging (MRI) is now established as the method of choice to evaluate focal liver lesions [7, 8]; furthermore, thanks to the introduction of hepatobiliary con- trast agents, the possibility to characterize lesions is really improved [9, 10]. Gadobenate dimeglumine and gadoxetic acid disodium (Gd-EOB-DTPA) are hepatobiliary contrast agents currently available [11]. Gadoxetic acid disodium (gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid, Gd-EOB-DTPA, Primovist, Bayer HealthCare, Berlin, Germany) is an hepatobiliary MR contrast agent which offers the combined properties of an extracellular space contrast medium during the vascular-interstitial phases and a liver-specific agent, with an hepatobiliary phase at 20 min after intravenous contrast injection [12]. Recent studies highlight the significant role of Gd-EOB- DTPA-MRI in the diagnosis of hepatocellular carcinoma [13, 14] and suggest that MRI achieves the greatest accuracy in differentiating HCA from FNH with the introduction of liver hepatocyte-targeted contrast agents [15, 16]. However, the inflammatory HCA presents pathological features similar to FNH; in fact, this subtype of HCA can mimic FNH on Gd-EOB-DTPA-MRI [17]. We describe the case of a 22-year-old obese diabetic wom- an, on oral contraceptive therapy, who presents constant and intense upper abdominal pain as the main symptom of a large HCA. This case report was approved by our Institutional Re- view Board and patients’ informed consent was waived.