A 29-year-old woman taking combined oral contraceptives presents with sudden right upper quadrant pain, hypotension, and hemoperitoneum. CT shows a ruptured 6 cm well-demarcated liver mass. Which feature explains this lesion's propensity to bleed?

• A Portal venous hypertension within the lesion
• B Centrilobular congestion from outflow obstruction
• C Invasion of hepatic veins by tumor thrombus
• D Unpaired arterioles feeding plates of hepatocytes without portal tracts ✓

Explanation

Hepatic adenoma consists of benign hepatocyte plates supplied solely by unpaired thin-walled arterioles, lacking portal tracts and normal vascular architecture. These fragile vessels make rupture with life-threatening intraperitoneal hemorrhage the feared complication, particularly during pregnancy or with large lesions. Estrogen exposure promotes adenoma formation, and lesions larger than 5 cm are generally resected.

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

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