Hepatic Adenoma Carries the Highest Risk of Spontaneous Rupture Among Liver Lesions

Among the liver lesions listed, hepatic adenoma carries the significant risk of spontaneous rupture, making option A the correct answer.

Characteristics and Rupture Risk of Different Liver Lesions

Hepatic adenomas are rare benign liver tumors with a significant risk of severe complications, including spontaneous bleeding, rupture, and peritoneal hemorrhage 1
The risk of rupture is associated with several key factors:
- Adenomas lack a complete tumor capsule and have peliotic sinusoids with no scar tissue, which predisposes them to intralesional hemorrhage 1
- They are fed solely by arterial vessels and lack portal venous supply, creating high-pressure vascular structures 1
- Larger tumor size (>5 cm) significantly increases rupture risk, with no tumors <5 cm reported to rupture in multicenter analyses 2
- Recent hormone use (within 6 months) is independently associated with higher rupture risk (OR 4.5) 2
Rupture occurs in approximately 25% of hepatic adenomas, with potentially life-threatening consequences 2

Simple hepatic cysts are the most common benign liver lesions 3
Spontaneous rupture of hepatic cysts is extremely rare, with only a few case reports documented 1
Even when rupture occurs, most patients experience full recovery, though a few fatal outcomes have been reported 1
The low number of rupture observations compared to the high prevalence of hepatic cysts (up to 18% in the general population) confirms that symptomatic cyst rupture is a rare event 1

Hepatic hemangiomas are the most common benign liver tumors with a prevalence of 0.4-7.3% 4
For most hemangiomas, the risk of rupture is extremely low 4
Even giant hemangiomas (>10 cm) have a rupture risk of only approximately 5%, primarily in peripherally located and exophytic lesions 4
No specific treatment is indicated for asymptomatic hemangiomas regardless of size according to guidelines 4

Bile duct hamartomas (von Meyenburg complexes) are benign malformations of the biliary tract 5
These lesions have no documented significant risk of spontaneous rupture in the literature 5
They are typically small, asymptomatic, and discovered incidentally 5

For hepatic adenomas, the risk of rupture warrants consideration of prophylactic intervention:
- Adenomas approaching 4 cm and those in patients requiring hormonal therapy should be considered for surgical therapy 2
- Ruptured adenomas often require more extensive interventions including blood transfusions (32% vs 9% for non-ruptured), preoperative embolization (16% vs 1%), and major hepatic resection (65% vs 32%) 2
In cases of acute rupture with hemodynamic instability, initial management may include:
- Arterial embolization to control bleeding 6, 7
- Surgical intervention with packing or resection depending on the patient's condition 6

Hepatic adenomas may present with acute abdominal pain and hemodynamic instability when ruptured 8, 7
Multidetector CT can identify intraparenchymal and subcapsular hematomas associated with adenoma rupture 8
Conservative management may be appropriate for stable patients with ruptured adenomas, with definitive resection performed later if indicated 6
Adenomas with hemorrhage/rupture do not necessarily require immediate liver resection if the patient can be stabilized 6