What is the main risk associated with hepatic adenoma?

The primary risk associated with hepatic adenoma is rupture and bleeding. Hepatic adenomas are benign tumors of the liver that can occur particularly in young women and are often linked to the use of oral contraceptives. Although these tumors are generally not malignant, they can become large enough to pose a significant risk of rupture, which can lead to significant intra-abdominal hemorrhage. This risk of rupture is especially important in instances where the adenoma is larger than 4-5 cm, as the likelihood of complications increases with size.

When considering the other potential risks associated with hepatic adenomas, such as malignancy, while there is a small chance for malignant transformation, especially in adenomas that are larger or have atypical features, this is not the chief concern compared to the immediate risk of rupture and significant bleeding. Similarly, obstruction of the bile duct and portal hypertension are complications that are more closely associated with other liver diseases or masses rather than being a direct concern from hepatic adenomas themselves. Thus, the most pressing risk from hepatic adenomas is indeed rupture and subsequent bleeding.