A 32-year-old woman on oral contraceptive pills for 8 years presents with acute right upper quadrant pain. CT shows a well-capsulated 6 cm liver mass with a central stellate scar. Biopsy shows hepatocytes arranged in thick plates with bile ductules and a central fibrotic scar with abnormal vessels. What is the diagnosis?

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

Explanation

Focal nodular hyperplasia (FNH) is characterized by a central stellate scar with abnormal vessels and bile ductules, and benign hepatocytes in thick plates. It is not premalignant and rarely ruptures. Hepatocellular adenoma lacks bile ductules and a true central scar, and carries rupture risk especially when >5 cm. Fibrolamellar HCC occurs in young patients without cirrhosis but shows lamellar fibrosis and large eosinophilic cells. Hemangioma is a vascular lesion without hepatocytes.

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.