What is the difference between hepatic adenoma and hepatic hemangioma?

From the Guidelines

Hepatic adenomas and hemangiomas should be managed differently, with adenomas requiring close monitoring and potential surgical resection due to their risk of hemorrhage and malignant transformation, while hemangiomas typically require no treatment unless symptomatic. Hepatic adenomas are rare, solid tumors that occur predominantly in women taking oral contraceptives, while hemangiomas are the most common benign liver tumors composed of blood vessels 1. Adenomas typically appear as well-defined, heterogeneous lesions on imaging with potential for hemorrhage and malignant transformation (5-10% risk), particularly when larger than 5 cm 1. In contrast, hemangiomas appear as well-defined hypervascular lesions with peripheral nodular enhancement and central fill-in on contrast imaging, and rarely cause symptoms or have malignant potential 1.

Key Differences in Management

• Hepatic adenomas:
  • Require close monitoring, especially during pregnancy 1
  • May need surgical resection if symptomatic or large 1
  • Discontinuation of oral contraceptives is recommended 1
• Hepatic hemangiomas:
  • Typically require no treatment unless symptomatic 1
  • Can be managed conservatively, with resection rarely required 1
  • Close monitoring is recommended, especially for larger lesions (>10 cm) 1

Considerations for Pregnancy

• Hepatic adenomas: pregnancy is not contraindicated for lesions less than 5 cm in diameter, but prophylactic treatment with embolization or resection should be considered for larger lesions 1
• Hepatic hemangiomas: do not preclude pregnancy, but close monitoring is recommended, especially for larger lesions (>10 cm) 1

From the Research

Hepatic Adenoma vs Hemangioma

• Hepatic adenoma and hemangioma are two distinct types of liver tumors with different characteristics and treatment approaches 2, 3.
• Hepatic adenoma is a rare benign liver tumor with increasing incidence, affecting young women, and has a risk of rupture and bleeding 2.
• Hemangioma, on the other hand, is a common benign liver tumor, often asymptomatic, but can cause symptoms due to its size or location 4, 3.

Diagnosis and Treatment

• The diagnosis of hepatic adenoma and hemangioma can be challenging, and a combination of imaging techniques such as ultrasonography, computed tomography, and labeled red blood cell scanning is often used to differentiate between the two 3.
• Treatment for hepatic adenoma typically involves resection, especially for larger tumors or those with a high risk of rupture, while hemangioma can be treated with radiofrequency ablation (RFA) or observation 4, 2, 5.
• RFA has been shown to be a safe and effective treatment for hepatic hemangiomas, with advantages including minimal invasiveness, definite efficacy, and high safety 5, 6.

Radiofrequency Ablation for Hemangioma

• RFA can be used to treat large hepatic hemangiomas, with a high success rate and low risk of complications 4, 6.
• A "three-step" RFA technique has been developed, which involves ablating the feeding artery, aspirating blood from the tumor, and then ablating the lesion, showing promising results in terms of safety and efficacy 6.
• However, the treatment approach for hepatic adenoma is more individualized, taking into account the size, location, and molecular characteristics of the tumor, as well as the patient's symptoms and overall health 2.