Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for evaluation of a hepatic lesion identified on imaging, consistent with HNF1A-mutated hepatic adenoma. Patient reports [asymptomatic/abdominal discomfort/pain]. History of [oral contraceptive use/metabolic syndrome/MODY3]. No history of weight loss, jaundice, or constitutional symptoms. Lesion characteristics on MRI show diffuse steatosis and signal loss on out-of-phase imaging.
Clinical Examination Findings
Abdominal examination: Soft, non-tender, non-distended. No palpable hepatomegaly or masses. Liver span within normal limits. No stigmata of chronic liver disease (no spider angiomata, palmar erythema, or ascites). Cardiovascular and pulmonary exams are unremarkable.
Treatment Protocol
Management plan: 1. Discontinue oral contraceptives or exogenous estrogens immediately. 2. Weight loss and metabolic optimization if associated with metabolic syndrome. 3. Serial monitoring with MRI (without hepatobiliary contrast) every 6-12 months to assess for growth or hemorrhage. 4. Surgical resection considered if lesion >5cm, symptomatic, or if diagnostic uncertainty persists.