A 32-year-old woman comes to the office due to abnormal liver imaging. The patient went to the emergency department a week ago for severe right flank pain radiating to the groin. A CT scan revealed a small ureter calculus, which she passed spontaneously the following day. The scan also found a solitary liver lesion, and the patient was advised to follow up with her primary care physician. She reports no right upper quadrant pain, nausea, jaundice, or clay-colored stool. She has no chronic medical problems and has no history of surgery or blood product transfusions. There is no history of cancer or liver disease in her family. She has taken combined oral contraceptives for the past 8 years. The patient does not use tobacco, alcohol, or illicit drugs. She works in a bank, is in a monogamous relationship with her husband, and recently traveled to Europe for her honeymoon. Vital signs are within normal limits. There is no scleral icterus, mucosal lesions, lymphadenopathy, or skin rash. Cardiopulmonary examination shows no abnormalities. Bowel sounds are active in all quadrants. The abdomen is nondistended, soft, and nontender. Liver is not enlarged, and spleen is not palpable. Laboratory results are as follows: A CT scan of the abdomen reveals a 3-cm, well-demarcated lesion in the right lobe of the liver that shows peripheral enhancement with intravenous contrast administration. There are no areas of hemorrhage, necrosis, or scarring. The remainder of the liver is normal. Which of the following is the most appropriate response to this patient regarding her liver lesion?

Question

A 32-year-old woman comes to the office due to abnormal liver imaging.  The patient went to the emergency department a week ago for severe right flank pain radiating to the groin.  A CT scan revealed a small ureter calculus, which she passed spontaneously the following day.  The scan also found a solitary liver lesion, and the patient was advised to follow up with her primary care physician.  She reports no right upper quadrant pain, nausea, jaundice, or clay-colored stool.  She has no chronic medical problems and has no history of surgery or blood product transfusions.  There is no history of cancer or liver disease in her family.  She has taken combined oral contraceptives for the past 8 years.  The patient does not use tobacco, alcohol, or illicit drugs.  She works in a bank, is in a monogamous relationship with her husband, and recently traveled to Europe for her honeymoon.  Vital signs are within normal limits.  There is no scleral icterus, mucosal lesions, lymphadenopathy, or skin rash.  Cardiopulmonary examination shows no abnormalities.  Bowel sounds are active in all quadrants.  The abdomen is nondistended, soft, and nontender.  Liver is not enlarged, and spleen is not palpable.  Laboratory results are as follows:  A CT scan of the abdomen reveals a 3-cm, well-demarcated lesion in the right lobe of the liver that shows peripheral enhancement with intravenous contrast administration.  There are no areas of hemorrhage, necrosis, or scarring.  The remainder of the liver is normal.  Which of the following is the most appropriate response to this patient regarding her liver lesion?

Quizplus · Accepted Answer

Explanation: 11ec2b69_bf3b_f22c_8f63_21b0d60f418b_MD0005_00 Hepatic adenoma is a benign epithelial tumor of the liver seen primarily in young women on combination oral contraception. Most cases are asymptomatic and discovered incidentally on imaging for other conditions, but tumors may grow large enough to cause episodic abdominal pain, rupture, or hemorrhage. Physical examination and laboratory tests are usually normal. Diagnosis is typically confirmed when CT scan of the abdomen reveals a well-demarcated lesion in the right lobe of the liver that shows peripheral enhancement with intravenous contrast (early phase). Hepatic adenomas <5 cm are often managed conservatively as the discontinuation of oral contraception can result in tumor regression. Those with larger or symptomatic adenomas usually require surgical resection. As malignant transformation can rarely occur, serial imaging and alpha-fetoprotein levels are typically required.(Choice A) Focal nodular hyperplasia is a benign liver lesion due to hyperplastic liver cells. Most cases arise in young women and are discovered incidentally on imaging for other conditions. However, CT scan with contrast usually shows uniform enhancement (not peripheral). (Choice B) Hepatic adenomas often bleed following needle biopsy, and the amount of tissue obtained is often insufficient for diagnosis. As such, needle biopsy is not typically performed. Suspected hepatic adenomas are usually diagnosed by imaging. (Choice C) Hepatic adenomas are benign lesions, and resection is only required in patients with symptoms or lesions >5 cm. Patients who are asymptomatic with lesions <5 cm do not require resection; they should discontinue oral contraception.(Choice E) Echinococcus is a parasitic infection that often causes hepatic cysts. Patients are frequently asymptomatic for years after infection. CT scan typically reveals a cyst with fluid, peripheral calcification, and septation. Educational objective: Hepatic adenoma is most commonly seen in young women on oral contraceptive therapy. Most cases are asymptomatic and are found incidentally on imaging for another condition. CT scan of the abdomen with contrast typically reveals a well-demarcated liver lesion with peripheral enhancement (early phase). Asymptomatic lesions <5 cm are usually managed with discontinuation of oral contraception. Symptomatic patients and patients with larger lesions should undergo surgical resection.

A 32-Year-Old Woman Comes to the Office Due to Abnormal