A 31-year-old woman taking combined oral contraceptives has a 7 cm solitary right-lobe liver lesion discovered after acute right upper quadrant pain. CT shows a heterogeneously enhancing mass with areas of haemorrhage. Beta-hCG and AFP are normal. The most appropriate management is:

• A Elective hepatic resection ✓
• B Stop oral contraceptives and follow with imaging at 6 months
• C Transarterial embolisation as definitive therapy
• D Percutaneous biopsy to confirm histology

Explanation

The findings indicate hepatic adenoma complicated by haemorrhage. Adenomas larger than 5 cm carry substantial risk of life-threatening rupture and malignant transformation to hepatocellular carcinoma, so elective resection is recommended even in the absence of malignancy. Stopping oestrogens alone is reasonable only for small asymptomatic adenomas under 5 cm. Transarterial embolisation is a temporising measure for active bleeding, not definitive. Percutaneous biopsy is avoided because of haemorrhage risk and sampling error in these vascular lesions.

Reference: Sabiston Textbook of Surgery, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.