Snapshot A 22-year-old woman presents to the emergency department for worsening right upper quadrant abdominal pain. She states that her symptoms have slowly progressed since the past 2 days. On physical exam, you note an athletic female with well-developed muscles. Her current medications include only oral contraceptives. Suddenly, the patient's blood pressure drops to 90/30 mmHg and her pulse is 145/min. Introduction Overview benign epithelial tumors arising in the liver typically arising in the right hepatic lobe and are usually solitary masses multiple adenomas can be seen in prolonged contraceptic use glycogen storage disorders hepatic adenomatosis Epidemiology demographic young women risk factors oral contraceptives anabolic androgens glycogen storage disorders type I and III pregnancy Introduction Symptoms abdominal pain may be localized in the epigastrum or in the right upper quadrant sudden, severe abdominal pain with hypotension suggests rupture of the hepatic adenoma into the peritoneum Physical examination abdominal mass can be seen in ~30% of cases Imaging Abdominal ultrasound indication typically assesses adenomas of the liver; however, findings are typically nonspecific findings large and often a right lobe lesion typically a hyperechoic mass CT abdomen with and without contrast indication another imaging modality to better characterize liver lesions findings may have changes consistent with hemorrhage MRI of the abdomen with and without contrast indication another imaging modality to better characterize liver lesions findings may show arterial enhancement Studies Histopathology gross soft, smooth, tanned masses containing prominent blood vessels histology adenoma cells that contains glycogen and lipids Differential Hepatocellular carcinoma differentiating factor increased α-fetoprotein hypervascular tumor on CT Treatment Lifestyle discontinuation of the oral contraceptives or steroids indication in asymptomatic patients some physicians may prefer resection Surgical resection indication in symptomatic and large adenomas Complications Malignant transformation Spontaneous rupture and hemorrhage