A 31-year-old woman taking combined oral contraceptives undergoes MRI for right upper quadrant pain. A 6 cm well-defined hepatic lesion shows heterogeneous signal with T1 hyperintense foci representing haemorrhage, small areas of fat, arterial phase hyperenhancement, and no central scar. Serum AFP is normal and the liver is non-cirrhotic. Which lesion behaviour is the most important reason for surgical resection in this tumour?
- A Risk of malignant transformation to cholangiocarcinoma
- B Invariable progression to cirrhosis
- C Risk of spontaneous rupture with life-threatening intraperitoneal haemorrhage ✓
- D High rate of portal vein invasion
Correct answer: C. Risk of spontaneous rupture with life-threatening intraperitoneal haemorrhage
Explanation
The imaging shows hepatic adenoma: a large lesion in a young woman on oestrogens, with intralesional haemorrhage and fat, normal AFP, and a non-cirrhotic liver. Adenomas larger than about 5 cm are resected mainly because of the risk of spontaneous rupture and massive intraperitoneal bleeding, particularly during pregnancy. Malignant transformation, when it occurs, is to hepatocellular carcinoma, not cholangiocarcinoma, and portal vein invasion is a feature of HCC rather than adenoma.
Reference: Grainger and Allison's Diagnostic Radiology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.