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Old 11-02-2012
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Arrow Gyrus Daily Questions; Internal Medicine #69

A 34-year-old woman presents to the emergency department with acute abdominal pain in her right upper quadrant The pain came on suddenly while she was at home watching a movie with her husband The patient reports that she has never felt this pain before and is also feeling lightheaded She denies nausea or vomiting Her past medical history is unremarkable She takes oral contraceptives On physical examination, her blood pressure is 88/50 mm Hg. heart rate is 110 beats/min, and temp is 365 C (97 7 F) Head, neck, chest, and cardiovascular examinations are normal Palpation of her abdomen reveals exquisite tenderness and guarding Fluid resuscitation is achieved and a computed tomography of the abdomen is performed. which demonstrates a heterogeneous subcapsular liver lesion with marked hemoperitoneum. Which of the following statements is the most accurate for this patient's current diagnosis.

A. After stabilizing the patient. a biopsy should be obtained
B. Malignant degeneration occurs in 0.5% of these lesions
C. The majority of these lesions are cold on a sulfur colloid scan
D. There is no relationship to oral contraceptive use
E. Ultrasound has the highest specificity for this lesion
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c. cold on sulfur scan
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C, this patient has Hepatic adenoma secondary to her OCP use.
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Hepatic adenomas are strongly associated with use of oral contraceptives, anabolic androgens, and glycogen storage disease. They are less commonly associated with pregnancy and diabetes mellitus.
  • Complete resolution is atypical.
  • The risk of malignant transformation remains even after the contraceptive or steroid use has been discontinued.
  • The risk of malignant transformation exists and is as high as 8-13%.
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Answer is C. The majority of these lesions are cold on a sulfur colloid scan

This patients has a clinical presentation that is classic for a hepatic adenoma. Hepatic adenomas are benign tumors of the liver.

It is associated with oral contraceptives , anabolic steroid use, type 1 and 3 glycogenstorage disease and prenancy.

USG is sensitive but have nonspecific appearance.
Contrast CT or MRI is more accurate.

Technetium 99 sulfur colloid scan furthur confirms.

Biopsy has risk of hemorrhage and contraindicated and surgical resection is recommenced.
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