Ectopic adrenal gland in the liver leading to a misdiagnosis of hepatocellular carcinoma: A case report

Table 1 Key differentiators of hepatic ectopic adrenal tissue vs hepatic malignancies

Feature	Hepatic ectopic adrenal tissue	Hepatocellular carcinoma	Metastatic tumors	Hepatic adenoma
Clinical context	Asymptomatic, normal AFP[1,5]	Cirrhosis, HBV/HCV history, elevated AFP[1,5]	Known primary malignancy (e.g., colorectal cancer), elevated CEA/CA19-9	Long-term oral contraceptive use in females, hemorrhage/necrosis
Lesion characteristics	Solitary, subcapsular (common in segment VII)	Solitary/multifocal, cirrhotic background	Multiple nodules with rim enhancement (“target sign”)[5,10]	Solitary, well-defined margins
CT/MRI enhancement	Heterogeneous arterial enhancement, rapid washout (“wash-in/wash-out”)	Homogeneous arterial enhancement, pseudocapsule	Peripheral arterial enhancement, delayed filling	Homogeneous arterial enhancement, persistent portal/delayed phase enhancement
Fat deposition	Common (signal dropout on opposed-phase imaging)	Rare (except steatotic variants)	Absent	Occasional hemorrhage/necrosis
DWI restriction	Mild restriction (moderate ADC values)	Marked restriction (low ADC values)	Severe restriction (very low ADC)[5,10]	Variable (depends on hemorrhage)
Pathologic markers	SF1+, melan-A+, inhibin-A+[1,5]	HepPar-1+, Glypican-3+[1,5]	Matches primary tumor (e.g., CK20+/CDX2+ for colorectal origin)	β-catenin nuclear+ (specific subtypes)

AFP: Alpha-fetoprotein; HBV: Hepatitis B virus; HCV: Hepatitis C virus; CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9; CT: Computed tomography; MRI: Magnetic resonance imaging; SF1: Steroidogenic factor-1; DWI: Diffusion-weighted imaging.