Diagnosing hepatocellular adenoma
Your doctor will examine you after listening to your complaints and will palpate your abdomen. A mass may be felt if the adenoma is large, and they will exclude other causes of abdominal pain resembling that of hepatocellular adenoma. They include:
- Other benign tumors as hemangiomas and focal nodular hyperplasia
- Liver cancer
- Problems with your gall bladder, although the pain in such cases is usually colicky and severe.
To exclude all other causes effectively, your doctor will need to run some tests and order imaging studies. Lab tests include:
- Liver function tests to detect abnormalities of liver function, which is rarely caused by adenoma, but highly suggest a malignant lesion.
- Tumor markers: Tumor markers are specific proteins secreted by cells whether normally or abnormally, and their increase beyond a certain level indicates the presence of a tumor or a group of tumors. In the case of liver cancer (hepatocellular carcinoma), the main tumor marker is called alpha-fetoprotein (AFP). Another tumor marker is CEA which can be elevated if the liver has cancer that has spread from somewhere else especially the colon.
- Routine lab tests such as a complete blood picture. They are not needed to diagnose a benign tumor, but can give a general impression about the health of a person and are needed before any operation.
Lab tests are hardly specific and without imaging studies, they cannot differentiate a benign tumor from a malignant one. Imaging studies needed in hepatocellular adenoma include:
- Ultrasound of the liver: Liver ultrasound can detect the presence of a mass and, in the hands of a skilled doctor, indicate whether the tumor is benign or malignant. It can also detect whether the liver is normal or has cirrhosis and exclude other causes for the same symptoms. It is cheap and available everywhere, making it the first imaging study ordered.
- CT scans: The main downside of ultrasound is that it cannot differentiate between the different benign tumors of the liver. CT scan with contrast can give a better look at the tumor and can potentially diagnose a hepatocellular adenoma based on its blood vessels arrangement.
- MRI: Magnetic resonance imaging, especially with the use of contrast agents, can diagnose a hepatocellular adenoma at a higher accuracy than CT, and it is particularly useful in patients who can not be exposed to radiation such as pregnant women.
Imaging studies are the main non-invasive methods of diagnosing a hepatocellular adenoma. However, a liver biopsy is the most diagnostic modality. Your doctor will sample a small amount of liver tissue using a special needle and under local anesthesia. Afterwards, they will examine it under the microscope to verify that it is not malignant.