Which lesion is strongly associated with estrogen exposure and has risk of hemorrhage or malignant transformation?

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Estrogen exposure promotes the growth of hepatic adenoma, a benign liver tumor classically seen in women using estrogen-containing contraceptives or during pregnancy. These lesions are often highly vascular and can rupture, leading to hemorrhage, especially if they are large or during pregnancy when blood flow increases. There is also a real risk of malignant transformation, particularly in subtypes with beta-catenin activation, which can progress to hepatocellular carcinoma. So, hepatic adenoma is the lesion most strongly linked to estrogen exposure and carries both hemorrhage risk and malignant potential. By contrast, focal nodular hyperplasia is not driven by estrogen and generally has no malignant potential, hemangioma is a vascular malformation not specifically tied to estrogen, and cystadenoma is a rare lesion without a direct estrogen association.