A 38-year-old male patient, with no history of interest, was referred for investigation for abnormal hepatic biochemistry detected in routine analysis.
The patient reported no symptoms and the clinical examination revealed no findings of interest.
Hepatic biochemistry showed only elevation of stasis enzymes, FA 731 U/L and GGT 276 U/L. The rest of analytical studies were normal, including alpha-fetoprotein, CEA and CA 19.9.
Serology for B, C and HIV was also negative.
Liver ultrasound showed a solid mass in the right hepatic lobe, about 7 cm in diameter, well defined.
The computed tomography (CT) revealed a focal multifocal lesion in the right lobe of about 7 x 5 cm; in the non-contrast-enhanced sections, the lesion was poorly defined, with parenchymal areas adjacent to the rest of the liver.
After intravenous contrast administration, the lesion had higher uptake in its center than the rest of the parenchyma, and in a late phase a capsule appeared hyperdense with respect to the lesion.
The data were suggestive of hepatic adenoma, without ruling out well-differentiated hepatocarcinoma.
The FNA performed was not conclusive.
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With the diagnosis of probable hepatic adenoma, he underwent surgical treatment.
A J-laparotomy revealed a mass located mainly in segments VI and VII, and intraoperative ultrasound confirmed that it was a single lesion and the margin of section was determined.
Cholecystectomy and liver resection were performed, performing an intermittent hepatic clamping with a resection margin of about 2 cm.
The hepatectomy specimen sent for study measured 18 x 8 x 8 cm and weighed 493.1 g.
It showed a solid 7 x 5 x 4 cm well-defined tumor of elastic consistency and brownish-red coloration.
It was formed by cords of hepatocytes with wide cytoplasm, without atypia and without signs of malignancy; the lesion presented an incomplete fibrous capsule, with areas of adjacent compression and parenchymatous hepatic dispersement.
Hepatic parenchyma showed no changes of interest.
The lesion was diagnosed as hepatic adenoma.
Postoperatively the patient developed a mild right pleural effusion that was resolved with physiotherapy.
In subsequent reviews liver lesions were not observed.
