American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the surgical intervention indicated for hepatocellular adenomas larger than 5 cm?

1. Mild resection

2. Watchful waiting

3. Surgical resection

4. Microwave ablation

The correct answer is: Surgical resection

The recommended surgical intervention for hepatocellular adenomas larger than 5 cm is surgical resection. Hepatocellular adenomas are benign liver tumors, but those larger than 5 cm carry a significant risk of complications, including hemorrhage and potential malignant transformation. Surgical resection is preferred for these larger adenomas, as it allows for the complete removal of the tumor and mitigates these risks. In cases where the adenomas are small or asymptomatic, watchful waiting might be considered; however, for tumors exceeding the 5 cm threshold, the potential complications necessitate a proactive surgical approach. Microwave ablation is another possible treatment modality, typically more suitable for smaller lesions or those in patients who cannot undergo surgery, but it is not the first line for larger adenomas due to the increased risk of incomplete treatment and recurrence. Therefore, surgical resection is the definitive management strategy for these larger, potentially problematic lesions.