A 32-year-old woman taking combined oral contraceptives for 8 years is found to have a solitary 6 cm right lobe hepatic lesion with homogeneous arterial enhancement and no central scar; it shows uptake on hepatobiliary phase scan. Serum AFP is normal. The most appropriate next step is:
- A Reassurance with continuation of oral contraceptives
- B Discontinuation of oral contraceptives and consideration of resection given the size above 5 cm ✓
- C Percutaneous ethanol injection
- D Systemic chemotherapy
Correct answer: B. Discontinuation of oral contraceptives and consideration of resection given the size above 5 cm
Explanation
Hepatic adenoma is strongly associated with oestrogen exposure. Adenomas larger than 5 cm carry a substantially increased risk of haemorrhagic rupture and malignant transformation, so current practice advises stopping oestrogen-containing contraceptives and offering surgical resection for lesions exceeding 5 cm. Normal AFP argues against hepatocellular carcinoma. Focal nodular hyperplasia, by contrast, has a central fibrous scar and does not require resection.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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