A 32-year-old woman taking combined oral contraceptives has a 7 cm right lobe liver lesion with heterogeneous arterial enhancement and no central scar. AFP is normal. Which statement best guides management?

• A Observation alone is safe regardless of size
• B Lesions larger than 5 cm warrant resection because of rupture and malignant transformation risk ✓
• C The lesion will regress fully once contraceptives are stopped, whatever its size
• D Biopsy is mandatory before any decision

Explanation

This is hepatocellular adenoma, strongly linked to estrogen exposure. Adenomas risk hemorrhage and malignant transformation, and this risk rises sharply with size, so resection is advised for lesions over 5 cm. Stopping hormones may cause smaller adenomas to regress, but regression cannot be assumed for a 7 cm lesion, so observation alone is unsafe. Biopsy risks bleeding and is not mandatory when imaging is typical.

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.