A 31-year-old woman taking combined oral contraceptives for 8 years has a 6.5 cm solitary right lobe liver lesion found incidentally. It shows uniform arterial enhancement without washout and no central scar. Serum AFP is normal. After stopping the contraceptive pill, the most appropriate management is:

• A Serial ultrasound surveillance every 6 months indefinitely
• B Surgical resection of the lesion ✓
• C Percutaneous needle biopsy to exclude malignancy
• D Transarterial chemoembolization

Explanation

This is a hepatic adenoma. Lesions 5 cm or larger carry a real risk of haemorrhage and malignant transformation, so resection is advised even after withdrawal of oestrogens, though regression occurs in some. Surveillance alone is accepted only for smaller asymptomatic adenomas. Biopsy is generally avoided because of bleeding risk and diagnostic uncertainty, and TACE plays no role in this vascular benign tumour.

Reference: Sabiston Textbook of Surgery, 21st ed.

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