Which of the following tumors is most likely to cause pain due to hemorrhage?

Hepatic adenomas are benign tumors of the liver that can cause significant pain, particularly if they undergo hemorrhage. These tumors are often associated with hormonal influences, particularly in young women who may have a history of oral contraceptive use. The risk of hemorrhage increases with the size of the adenoma and can lead to acute abdominal pain or discomfort.

When an adenoma hemorrhages, it can present as acute abdominal pain due to intralesional or intra-abdominal bleeding, which can also cause irritation of the peritoneum, leading to further pain and sometimes requiring surgical intervention. This characteristic makes hepatic adenomas notably linked to pain due to hemorrhagic events.

In contrast, cavernous hemangiomas are vascular lesions that rarely cause pain unless significant hemorrhage occurs, which is more uncommon. Focal nodular hyperplasia is another benign liver lesion that typically does not lead to pain or hemorrhage, as it is composed of a central scar and is not associated with vascular structures prone to bleeding. Lastly, hepatic lipomas are very rare and generally asymptomatic, and they do not usually lead to pain from hemorrhage either.