A 26-year-old woman presents with right upper quadrant discomfort. CT shows an 8 cm right lobe mass with a central fibrous scar. Serum AFP is within normal limits and there is no history of oral contraceptive use or cirrhosis. Biopsy shows large eosinophilic tumor cells arranged in cords separated by dense lamellar collagen bands. The most likely diagnosis is:

• A Focal nodular hyperplasia
• B Fibrolamellar hepatocellular carcinoma ✓
• C Hepatic adenoma, HNF1A-inactivated type
• D Intrahepatic cholangiocarcinoma

Explanation

Fibrolamellar HCC occurs in adolescents and young adults without cirrhosis, has a central scar radiologically, lamellar fibrosis histologically, and a normal AFP. The key distractor is focal nodular hyperplasia, which also shows a central scar but contains a central artery with radiating septa, bile duct proliferation in the scar, and lacks the malignant cytology and lamellar collagen. FNH is a hyperplastic response to a vascular anomaly, not a neoplasm.

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.