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Hepatic Adenomatosis: A Systematic Review of Definitions, Management, and Outcomes in Published Cases
Thomas Stirrat1, Stella Kim2, Deeptha Bejugam2
1Internal Medicine Residency Program, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Introduction:
Hepatic adenomatosis (HA), the multifocal phenotype of hepatocellular adenoma, is variably defined and managed.
Methods:
We performed a PRISMA-guided systematic review of MEDLINE, Embase, Web of Science, and CINAHL from inception through August 25, 2025, and included human case reports or case series with original clinical data.
Results:
The review included 54 reports describing 55 patients. Most patients were female (81.8%), with median age of 34 years (IQR 26-48). A ≥10-lesion threshold was used in 68.5% of definitions. When lesion burden was quantifiable, the median lesion count was 15 (IQR 10-30; range 4-200). The median largest-lesion diameter was 80 mm (IQR 50-100; maximum 170 mm), and 80.4% measured ≥5 cm. Magnetic resonance imaging (MRI) was reported in two-thirds of cases, whereas hepatobiliary-phase imaging and molecular subtyping were rarely described. Management included observation, resection, embolization, ablation, and transplantation, most often for size, hemorrhage risk, or malignancy concern; reported follow-up documented hemorrhage and malignant transformation in approximately 10% each, likely reflecting publication and severity bias.
Discussion/Conclusion:
This synthesis supports a pragmatic approach centered on a standardized operational definition, hepatobiliary-contrast MRI, selective targeted biopsy/molecular profiling of index lesions, withdrawal of exogenous hormones, and risk-adapted intervention for high-risk disease.
