In order to investigate the most appropriate management of adenomatous hyperplastic nodules in cirrhosis (AHNs), retrospective and prospective studies were undertaken. The retrospective study included 11 AHNs detected in nine patients, who were followed with ultrasonography (US) and fine-needle biopsy (FNB); seven of these lesions evolved into hepatocellular carcinoma (HCC) after a mean follow-up period of 11.4 months. The prospective study involved 19 AHNs (in 12 patients) that were submitted to percutaneous ethanol injection (PEI); all lesions underwent necrosis at the dynamic computed tomographic (CT) examination and at multiple FNBs performed 1 month after the end of treatment. In four patients studied with magnetic resonance (MR), all treated lesions were markedly hypointense in the T2-weighted images. No complications occurred after a total number of 114 alcohol injections. No local recurrences were observed after a mean follow-up period of 16.9 months. PEI should therefore be considered mandatory in the management of AHNs.