A 55-year-old woman is incidentally found to have a 4 cm hepatic adenoma on MRI. She is on oral contraceptive pills. What is the MOST important reason for recommending resection?

• A Hepatic adenomas never regress spontaneously
• B All adenomas >3 cm must be resected regardless of malignancy risk
• C Risk of malignant transformation to hepatocellular carcinoma and risk of spontaneous rupture ✓
• D Presence on OCP alone is sufficient indication for surgery

Explanation

Hepatic adenomas >5 cm carry a significant risk of spontaneous rupture (with life-threatening hemorrhage) and malignant transformation to HCC (up to 4.2%, particularly in beta-catenin-mutated subtype). For adenomas >5 cm (some guidelines say >3-4 cm), resection is recommended. OCP discontinuation should always be the first step; smaller adenomas often regress. However, at 4 cm in a woman on OCP with progressive potential, the hemorrhage and transformation risks justify surgery.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.