Multifocal hepatic adenoma in an adolescent female requiring right hepatic lobectomy: A case report

Hepatic adenomas are benign tumors that are extremely rare in adolescents. Proper and early management is essential to prevent associated hemorrhage and potential malignant transformation. We herein present a case of a 17-year-old female patient with obesity, precocious puberty, and oral contraceptive use that presented with abdominal pain, emesis, elevated liver enzymes, and leukocytosis. Magnetic resonance imaging identified two lesions within the right hepatic lobe: a 2.0× 6.8 × 2.0 cm T1-hyperintense semilunar component and a 5.9 x 7.2 × 7.2 cm T1-hypointense component suspicious for intralesional hemorrhage. A diagnosis of hepatic adenoma was made based on imaging characteristics and the patient's oral contraceptives were discontinued to prevent lesion expansion. The patient was discharged following improvements in her clinical presentation and was scheduled for follow up imaging. Three weeks later, the patient presented again with similar symptoms, suggestive of an acute exacerbation of her hepatic lesions. Repeat computed tomography imaging revealed free fluid in the pelvis and expansion of the larger lesion to 10.9 x 6.5 × 6.4 cm that was now bilobed with irregular borders. The lesions were unsuitable candidates for embolectomy and the patient ultimately underwent a right hepatic lobectomy and wedge biopsy of segment II for another lesion discovered intraoperatively. Pathological analysis identified three distinct masses in the right hepatic lobe and a single mass within segment II, all of which were consistent with a diagnosis of a benign multifocal hepatic adenoma. No residual tumor or recurrence was identified at 3-month follow-up imaging. Despite being benign, hepatic adenomas can present with rapid growth and aggressive clinical deterioration that may require urgent surgical resection.