A 35-year-old woman has a 4 cm liver lesion found incidentally. MRI shows homogeneous arterial enhancement with a central T2-bright scar that enhances on delayed images. She is completely asymptomatic and liver function tests are normal. What is the correct management?
- A No treatment, reassure the patient ✓
- B Stop oral contraceptives and repeat imaging in 6 months
- C Resection because of malignant potential
- D Transarterial embolization
Correct answer: A. No treatment, reassure the patient
Explanation
The central scar that enhances on delayed phases is characteristic of focal nodular hyperplasia, a benign hyperplastic response to a congenital arterial malformation. FNH has essentially no malignant or hemorrhagic potential, so asymptomatic lesions need no treatment or follow-up. Stopping contraceptives and surveillance apply to hepatic adenoma, the key distractor here, since adenomas can bleed and transform. Embolization is reserved for bleeding adenomas.
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.