Pathological features: Hepatic adenomas can be divided into hepatocellular adenomas, cholangiocellular adenomas and biliary hepatocellular adenomas (i.e., mixed adenomas) according to tumor cytology. The tumors are round or oval in shape, soft and yellowish-brown in texture, and most of them have complete envelope. The tumor diameter is 1-20 cm, and the diameter of symptomatic ones is more than 8 cm. 2/3 of liver adenomas are solitary, and the remaining 1/3 are multiple. A few of them may be tipped. Most biliary adenomas are located under the hepatic envelope and rarely have an envelope. They are mostly small grayish-white nodules and can become malignant. Mixed adenomas are usually seen in children. Clinical manifestations: About half of the patients have no conscious symptoms, and about 42.1% of the patients mostly present with right upper abdominal pain.5 One of the four patients summarized in this paper was asymptomatic, and three had different degrees of right upper abdominal pain. About 17.2-30% of the patients presented with acute intra-abdominal hemorrhage. Intra-abdominal hemorrhage is due to spontaneous bleeding from the tumor and breaking into the abdominal cavity. There are reports in the literature of acute bleeding episodes closely related to menstruation. A liver mass can often be found in symptomatic patients, and one patient in this group was seen for an epigastric mass. Ancillary tests: liver function and AFP tests are usually normal. The majority of hepatocellular adenomas appear as well-defined, round, hypodense masses on CT, as in the three cases herein, and a few are isodense. There is no significant enhancement after contrast injection. If scanned after hemorrhage, the hypodense tumor appears as a high-density area equivalent to fresh hemorrhage. Angres7 reported a case of hepatocellular adenoma with a peritumoral hyaline ring on CT. The ring did not change after contrast injection. Pathological examination demonstrated that the hyaline ring was an excess of fat vesicles within the hepatocytes of the tumor envelope. The diagnostic significance of this clear ring has yet to be confirmed in more cases. Radioisotope Ga-67 scan showed cold nodules and Tc-99m PMT showed early delayed uptake and excretion as well as radioactive sparse areas to provide a definitive diagnosis. One patient in this group of cases showed radiologically sparse areas. Hepatic angiography could not be distinguished from malignant liver tumor. ultrasound examination was not characteristic. Fine needle aspiration biopsy is helpful for diagnosis, but there is a risk of causing bleeding. One patient in our group was diagnosed clearly by fine needle aspiration biopsy. We believe that fine needle aspiration biopsy is a good method to make a clear diagnosis, but cases should be strictly selected. Diagnosis and differential diagnosis: The first thing to note is that men can also develop hepatic adenoma. There are two cases of male patients in this group. The second is the differential diagnosis with hepatocellular carcinoma. By reviewing the literature and combining our cases, we believe that the following points should be noted: (1) Medical history: Patients with hepatocellular carcinoma have a history of hepatitis and cirrhosis and are in poor general condition; patients with hepatic adenoma are mostly female and often have a history of long-term oral contraceptive use and are in better general condition. (2) Laboratory examination: patients with hepatocellular carcinoma mostly have abnormal liver function and increased AFP; while patients with hepatic adenoma mostly have normal liver function and AFP. (3) CT: Most liver cancer patients have blurred boundary, while liver adenoma patients have intact envelope and clear boundary. The CT examination of one patient in our group showed hypointense shadow with uniform enhancement and clear boundary; (4) Radioisotope Ga-67 scan showed mostly radioactive concentration in hepatocellular carcinoma, while in hepatic adenoma it showed mostly radioactive sparse area or defect.8 The isotope scan of one patient in our group suggested benign lesion. In our experience, a detailed comprehensive preoperative examination can lead to a diagnosis of benign disease in about half of the patients. Treatment: Because hepatocellular adenoma has the risk of bleeding and malignant transformation and is often not easily distinguished from hepatocellular carcinoma. Therefore, some scholars advocate that surgery should be performed once detected. Most scholars believe that hepatocellular adenoma larger than 5 cm should be actively treated by surgery; for tumors smaller than 5 cm, if they are asymptomatic or less symptomatic, CT or ultrasound examination should be performed periodically with the discontinuation of oral contraceptives; if they continue to increase in size, surgery should be performed. Croes11 has experience in treating eight cases of intra-abdominal hemorrhage due to rupture of hepatocellular adenoma. Four of these cases were treated conservatively with lobectomy or tumor resection after 2 to 4 months, respectively. The other 4 cases were treated with emergency laparoscopic exploration, 3 of which were successfully treated with gauze compression to stop bleeding and partial hepatectomy was performed 3 months later; the other 1 was treated with emergency partial hepatectomy. Most patients recovered well without complications after surgery, and all three patients were discharged from the hospital after partial hepatectomy with successful recovery. One patient was lost to follow-up after conservative treatment. Oral contraceptives should be prohibited in all cases, and radiotherapy or chemotherapy is usually ineffective. For patients with an ambiguous diagnosis that cannot be distinguished from hepatocellular carcinoma and for patients with symptomatic larger hepatic occupancies, we believe that early exploration should be performed regardless of their size, as long as there is no contraindication to surgery, to prevent delay in diagnosis and treatment.