A 34-year-old woman on combined oral contraceptives for 8 years is found to have a solitary 6 cm right lobe hepatic lesion. MRI shows a homogeneous arterial-enhancing mass without a central scar; biopsy confirms hepatocellular adenoma. The most appropriate next step is:
- A Stop oral contraceptives and repeat imaging in 6 months
- B Transarterial chemoembolization
- C Surgical resection of the lesion ✓
- D Radiofrequency ablation
Correct answer: C. Surgical resection of the lesion
Explanation
Adenomas larger than 5 cm carry a substantial risk of rupture, haemorrhage, and malignant transformation to hepatocellular carcinoma, so resection is advised regardless of symptoms. Stopping oestrogens with surveillance is reasonable only for smaller asymptomatic adenomas, typically under 5 cm. Transarterial embolization is reserved for acute bleeding from an adenoma, and ablation is not standard first-line therapy for a large resectable lesion.
Reference: Blumgart's Surgery of the Liver, Biliary Tract and Pancreas, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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