A 35-year-old woman presents with a 7 cm liver lesion. MRI shows a large central stellate scar with radiating fibrous septa, lobulated borders, and arterial enhancement with washout on venous phase. Serum AFP is normal. Oral contraceptive use for 10 years. Which lesion best fits this description and what is the appropriate management?

• A Focal nodular hyperplasia (FNH); no resection needed, OCP cessation and surveillance
• B Hepatocellular carcinoma; formal hepatic resection with curative intent
• C Fibrolamellar carcinoma; chemotherapy followed by resection
• D Hepatic adenoma; resection recommended given size >5 cm and OCP use (haemorrhage/malignant transformation risk) ✓

Explanation

The central stellate scar with arterial enhancement and washout is more typical of hepatic adenoma in this clinical context (young woman, prolonged OCP use) rather than FNH, which characteristically shows sustained enhancement without washout. Hepatic adenomas >5 cm carry a significant risk of haemorrhage (25–30%) and malignant transformation (10%); current guidelines recommend resection for lesions >5 cm or with β-catenin mutation regardless of size. FNH rarely bleeds and can be safely observed.

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.