A 55-year-old man with hepatitis C cirrhosis is found to have a single 4 cm liver nodule with arterial enhancement and washout on CT. No vascular invasion, no extrahepatic spread. Which of the following statements regarding his eligibility for liver transplantation is correct?
- A He does not meet Milan criteria because the lesion is >3 cm
- B He meets the Milan criteria because the lesion is ≤5 cm ✓
- C He meets Milan criteria only if AFP is <400 ng/mL
- D He does not meet Milan criteria because washout excludes transplant
Correct answer: B. He meets the Milan criteria because the lesion is ≤5 cm
Explanation
The Milan criteria for HCC in cirrhosis are: single lesion ≤5 cm or up to 3 nodules each ≤3 cm, no macrovascular invasion, and no extrahepatic spread. This patient has a single 4 cm lesion with typical imaging features and no invasion, so he is within Milan criteria and a transplant candidate. AFP level is not part of Milan criteria. Washout is a diagnostic feature, not an exclusion.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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