Review Question - QID 106369

This patient with a history of oral contraceptive use and a hepatic mass visualized on CT presenting with hemodynamic instability likely has a hepatic adenoma.

Hepatic adenomas are benign tumors of the liver that develop most commonly in otherwise healthy women in association with the use of oral contraceptives or other estrogen-containing medications. Patients with glycogen storage disorders or metabolic syndrome are also more likely to develop hepatic adenomas. Hepatic adenomas are highly vascular and occasionally rupture, leading to intraperitoneal bleeding and hemodynamic compromise. Hepatic adenomas are often clinically silent, but can present with weight loss, jaundice, weakness, and RUQ or epigastric pain. Physical examination may reveal hepatomegaly, palpable masses, or distension. Diagnosis is often made with imaging, including ultrasound or computed tomography.

Miksanek reviews the topic of benign hepatic tumors noting that the incidence of hepatic adenomas has risen sharply since the widespread use of oral contraceptives, but that recent imaging advances have also increased the frequency of diagnosis. The author notes that liver enzyme studies are generally normal, and that the tumors are usually clinically silent and only incidentally discovered at autopsy.

Figure A shows a CT scan of the abdomen demonstrating a hepatic adenoma. Note the large, heterogeneous appearance of the mass.

Incorrect Answers:
Answer 1: Focal nodular hyperplasia is also a benign neoplasm of the liver. However, it is not associated with exposure to estrogen and is not commonly complicated by rupture or bleeding.

Answer 3: Hepatic cyst is a benign cystic mass that develops in the liver. Like most cystic masses, it appears on imaging as a homogenous, well-circumscribed mass. It is not associated with oral contraceptive use and does not commonly cause bleeding.

Answer 4: Hepatic metastasis more commonly presents with multiple liver masses in patients with a primary malignancy such as colon cancer. It would be unusual in a young woman with a solitary liver mass.

Answer 5: Hepatocellular carcinoma is a malignant hepatic neoplasm that is associated with chronic alcohol use or chronic viral hepatitis infection. It is not associated with oral contraceptive use and would be uncommon in a 28-year-old woman.

Bullet Summary:
Hepatic adenoma is a benign liver mass associated with estrogen exposure that is prone to rupture and hemorrhage.