A 34-year-old woman on combined oral contraceptives presents with sudden severe right upper quadrant pain, hypotension, and falling hematocrit. CT shows hemoperitoneum and a ruptured 6 cm hepatic mass in a normal non-cirrhotic liver. Which factor best explains both the development of this tumor and its rupture?

• A Estrogen-driven proliferation of hepatocytes with sinusoidal dilation and thin-walled vessels ✓
• B Congenital arteriovenous malformation with secondary capsular stretch
• C Iron overload causing parenchymal fibrosis and vascular fragility
• D Chronic hepatitis B integration with dysplastic nodule formation

Explanation

This is a ruptured hepatocellular adenoma. Estrogens promote hepatocyte proliferation and also cause sinusoidal dilation and telangiectasia, producing large thin-walled vessels that bleed easily; rupture risk rises sharply above 4 cm size. FNH arises from an arteriovenous malformation but virtually never ruptures, making it the key distractor. HBV-related HCC arises on cirrhotic background in this age group only rarely, and hemochromatosis causes fibrosis rather than sudden hemorrhage.

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.