A 32-year-old woman taking combined oral contraceptives for 8 years is found incidentally to have a 7 cm right lobe liver lesion. MRI shows intense homogeneous arterial enhancement without washout, no central scar, and a normal background liver. She has mild right upper quadrant discomfort. The most appropriate management is:

• A Stop oral contraceptives and observe with serial imaging
• B Transarterial embolisation as definitive therapy
• C Stop oral contraceptives and proceed to resection ✓
• D Liver biopsy to confirm the diagnosis

Explanation

The imaging is typical of hepatocellular adenoma, an oestrogen-driven benign tumour. Lesions larger than 5 cm carry a significant risk of life-threatening haemorrhage and malignant transformation, so resection is advised even after stopping hormones. Observation alone is reserved for adenomas under 5 cm after hormone withdrawal. Biopsy risks bleeding and is generally avoided once imaging is characteristic.

Reference: Blumgart's Surgery of the Liver, Biliary Tract and Pancreas, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.