A 31-year-old woman found to have a 4 cm hepatic lesion on ultrasound undergoes MRI, which shows homogeneous arterial enhancement with a central area that is hypointense on T1 and hyperintense on T2. Hepatobiliary phase imaging shows retention of contrast in the lesion except for the central scar. She takes no medications. The correct management is:
- A Stop oestrogen therapy and repeat imaging at 6 months
- B Reassurance and no follow-up imaging ✓
- C Resection to exclude malignant transformation
- D Radiofrequency ablation to prevent haemorrhage
Correct answer: B. Reassurance and no follow-up imaging
Explanation
The central scar that is bright on T2, uniform enhancement and hepatobiliary contrast retention identify focal nodular hyperplasia. FNH is a hyperplastic response to a pre-existing arterial malformation, has no malignant potential and essentially never bleeds, so asymptomatic patients need no treatment or routine follow-up. Stopping oestrogens applies to hepatocellular adenoma, the lesion it most often needs distinguishing from.
Reference: Blumgart's Surgery of the Liver, Biliary Tract and Pancreas, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.