A 29-year-old woman taking combined oral contraceptives presents with sudden right upper quadrant pain and hypotension. CT shows a 6 cm heterogeneous right lobe lesion with acute haemorrhage into the peritoneum. The most likely diagnosis is:

• A Focal nodular hyperplasia
• B Fibrolamellar hepatocellular carcinoma
• C Haemangioma
• D Hepatic adenoma ✓

Explanation

Hepatic adenoma occurs almost exclusively in women exposed to oestrogens, and its feared complication is spontaneous rupture with intraperitoneal haemorrhage, presenting exactly as here. Focal nodular hyperplasia virtually never bleeds and shows a central scar. Haemangiomas may bleed rarely but lack the oestrogen link. Fibrolamellar carcinoma affects young patients but presents as a slow-growing mass with raised vitamin D12 binding capacity, not catastrophic haemoperitoneum.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.