Adrenohepatic Adhesion/Fusion Mimicking Hepatic Invasion: Two Cases of Benign Right Adrenal Lesions and a Review of the Literature.

Background and Clinical Significance: Adrenohepatic fusion (AHF) represents a developmental anatomical variant chracterised by direct continuity between the right adrenal cortex and hepatic parenchyma, often accompanied by partial or complete absence of the intervening fibrous capsule and periadrenal fat plane. In contrast, adrenohepatic adhesion (AHA) denotes a close apposition of the two organs with a shared capsule, but without actual parenchymal intermingling. AHF/AHA becomes most clinically relevant when a lesion arises in the right adrenal gland. In this setting, cross-sectional imaging frequently demonstrates apparent continuity of the lesion across the interface. These features are conventionally interpreted as signs of local invasion, and this may lead to diagnostic misclassification as hepatocellular carcinoma, adrenocortical carcinoma, or metastatic disease, resulting in unnecessarily extensive hepatectomy in cases of benign disease. Case presentation: Herein we report two female patients, 27 and 63 years old, who underwent right antero-lateral laparoscopic adrenalectomy. In the first patient, a heterogeneous, partly calcified haemorrhagic cyst was connected to the hepatic capsule, and AHA was the final finding. In the second patient, a cortical adenoma at the liver-adrenal interface was diagnosed as AHF.

Conclusions

AHF and AHA should be considered when right adrenal mass is inseparable from hepatic segment VI or VII, particularly when other imaging and biochemical characteristics do not support malignancy. Close coordination between radiology and pathology can help reduce unnecessary liver resections, improve surgical strategies, and support appropriately conservative adrenal resection.