A 33-year-old woman on oral contraceptives is found incidentally to have a 4 cm hepatic lesion. CT shows homogeneous arterial enhancement with a central low-attenuation stellate area. The lesion is asymptomatic and her liver function tests are normal. What is the most appropriate management?
- A Stop oral contraceptives and observe, as this represents focal nodular hyperplasia ✓
- B Urgent resection because of high risk of hemorrhage
- C Systemic chemotherapy
- D Radiofrequency ablation
Correct answer: A. Stop oral contraceptives and observe, as this represents focal nodular hyperplasia
Explanation
The central stellate scar with homogeneous arterial enhancement is characteristic of focal nodular hyperplasia, a benign hyperplastic response to an arterial malformation. FNH is not hormone dependent, does not bleed or transform, and needs no excision; stopping the pill and observing is standard. This distinguishes it from hepatic adenoma, where OCP cessation matters more and larger lesions may need resection.
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.