A 50-year-old woman is found to have a solitary 4 cm hepatic lesion on CT done for an unrelated reason. She has no history of chronic liver disease or viral hepatitis. The lesion is hypervascular on arterial phase with washout on the portal venous phase. AFP is 2.1 ng/mL (normal). She takes the combined oral contraceptive pill. What is the most likely diagnosis?
- A Hepatocellular adenoma ✓
- B Hepatocellular carcinoma
- C Focal nodular hyperplasia
- D Haemangioma
Explanation
Hepatocellular adenoma is strongly associated with long-term oral contraceptive use and typically presents in young to middle-aged women as a hypervascular lesion on CT or MRI. AFP is normal, distinguishing it from hepatocellular carcinoma. Focal nodular hyperplasia classically shows a central scar with spoke-wheel arterial enhancement and does not have washout; it has no malignant potential. Hepatocellular carcinoma is uncommon without underlying cirrhosis and is associated with raised AFP. Haemangiomas show peripheral nodular enhancement with progressive fill-in, not washout.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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