A 36-year-old woman with a newly discovered liver nodule.

A 36-year-old woman was referred for a specialist opinion regarding a newly discovered liver nodule.

The lesion was detected by ultrasonographic examination during assessment of acute right hypochondriac pain.

She was otherwise healthy, and was taking oral contraceptive pills.

The lesion was 2x3 cm in size and showed central hyper-echoic area suggestive of hemorrhage. 

These features were further confirmed by MRI.

Her biochemistry was normal including serum alpha-fetoprotein.

The best therapeutic option is:

A-        Monitoring with ultrasonography every 3 months

B-        Triphasic CT scanning

C-        Trans-arterial chemo-embolization

D-       Radiofrequency ablation

E-         Surgical resection

Check the answer and explanation below

Answer : E

Explanation: 

The clinical scenario, combined with the radiological findings, is suggestive of hepatic adenoma (also called hepatocellular adenoma).

Oral contraceptives are associated with increased risk of hepatic adenomas.

Adenoma should be resected if it's symptomatic (hemorrhage or necrosis) , or it's 5 cm or more.

Asymptomatic and smaller adenomas are monitored on a regular basis.

Triphasic CT (looking for the typical contrast uptake pattern of hepatocellular carcinoma) is not expected to change the diagnosis because of the normal serum alpha-fetoprotein.

Trans-arterial chemo-embolization and  radiofrequency ablation are local therapies for hepatocellular carcinoma and not indicated for the treatment of hepatic adenoma.