A 31-year-old woman taking combined oral contraceptives for 8 years is found to have a solitary, well-encapsulated 3 cm right lobe lesion. MRI shows homogeneous arterial enhancement without central scar and no washout. Biopsy confirms hepatocellular adenoma. Serum AFP is normal. The most appropriate next step is:
- A Discontinue oral contraceptives and repeat imaging in 6 months ✓
- B Immediate left or right hepatectomy
- C Transarterial chemoembolisation
- D Radiofrequency ablation
Correct answer: A. Discontinue oral contraceptives and repeat imaging in 6 months
Explanation
Hepatocellular adenoma is strongly related to oestrogen exposure and can regress after stopping oral contraceptives. Lesions smaller than 5 cm without beta-catenin activation are managed conservatively with drug withdrawal and serial imaging, while resection is advised for lesions that persist above 5 cm, enlarge, or are associated with pregnancy plans because of rupture and malignant transformation risk. RFA and TACE are not first-line for a small asymptomatic adenoma.
Reference: Blumgart's Surgery of the Liver, Biliary Tract and Pancreas, 6th ed.
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