Multiple 11C-acetate and 18fludeoxyglucose-avid hepatic tumours in a young woman: primary, secondary, or something else?

A 32-year-old lady presented with abdominal pain and computed tomography scan detected multifocal bilobar hepatic tumours. The tumours had heterogeneous radiological appearance. The largest tumour situated in left lateral section and was hypodense on arterial and portal venous phases. There were two small arterial enhancing tumours at segment 4a and 8, respectively. On dual-tracer positron emission tomography scan, these tumours were mostly 11C-acetate and 18FDG-avid, radiologically mimicking multifocal hepatocellular carcinoma. Immuno-histochemical staining after resection confirmed the diagnosis of inflammatory hepatic adenoma. The tumour cells expressed serum amyloid A and C-reactive protein.