A 32-year-old woman has an incidentally detected 4 cm left lobe liver lesion. MRI shows homogeneous arterial enhancement with a central T2-hyperintense stellate area that enhances on delayed images. AFP and CA 19-9 are normal. The most appropriate management is:

• A No treatment, confirmatory imaging only ✓
• B Resection to exclude malignancy
• C Transarterial chemoembolisation
• D Radiofrequency ablation

Explanation

The central stellate scar with delayed enhancement is characteristic of focal nodular hyperplasia, a benign hyperplastic response to an arterial malformation that carries no malignant potential and essentially never bleeds. Typical lesions need no treatment beyond confirmation of typical imaging features. Resection, ablation, and TACE are reserved for symptomatic, growing, or atypical lesions, and stopping oestrogen-containing contraceptives is not required for FNH.

Reference: Blumgart's Surgery of the Liver, Biliary Tract and Pancreas, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.