A 32-year-old woman taking combined oral contraceptives develops sudden severe abdominal pain with hypotension. CT shows a 6 cm right lobe liver lesion with intraperitoneal hemorrhage. Which feature of this lesion explains its tendency to bleed?

• A Thick fibrous capsule compressing the parenchyma
• B Extensive necrosis from rapid growth
• C Central vein thrombosis causing sinusoidal congestion
• D Arterialized blood supply with thin-walled unpaired arteries lacking portal tracts ✓

Explanation

Hepatic adenoma consists of benign hepatocytes supplied by purely arterial blood through thin-walled vessels that lack portal tracts and supporting stroma. This fragile arterialized network makes rupture with life-threatening intraperitoneal hemorrhage the classic complication, particularly in lesions larger than 5 cm and during pregnancy. The lesion typically lacks a true capsule, which kills option A, and its bleeding is vascular rather than congestive or necrotic in origin.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.