A 28-year-old woman on oral contraceptives undergoes ultrasound for right upper quadrant discomfort. Imaging shows a well-defined 5 cm hepatic lesion with a central stellate scar that enhances brightly on arterial phase. Biopsy shows malformed vessels, ductular reaction, and normal-appearing hepatocytes without capsules. What is the most likely diagnosis?

• A Focal nodular hyperplasia ✓
• B Hepatocellular adenoma
• C Fibrolamellar hepatocellular carcinoma
• D Cavernous hemangioma

Explanation

Focal nodular hyperplasia classically shows a central stellate scar containing thick-walled abnormal arteries, with radiating fibrous septa, ductular proliferation, and regenerative hepatocyte nodules. It is thought to represent a hyperplastic response to a vascular anomaly rather than a true neoplasm, and it does not rupture or transform. The central scar also occurs in fibrolamellar carcinoma, but that tumor occurs in adolescents and young adults without cirrhosis and shows large eosinophilic cells with lamellar fibrosis.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.