A 28-year-old woman undergoing ultrasound for vague right upper quadrant discomfort has a well-defined 4 cm hepatic mass. Contrast CT shows intense enhancement in the arterial phase with a central non-enhancing area that fills in on delayed images. Liver enzymes are normal. She takes no medications. What is the most likely diagnosis?

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

Explanation

The central scar that enhances on delayed phase is characteristic of focal nodular hyperplasia, a hyperplastic response to an underlying arteriovenous malformation. Histologically it shows a central stellate scar with thick-walled vessels radiating fibrous bands containing proliferating ductules. Fibrolamellar carcinoma also shows a central scar but occurs in adolescents with elevated AFP and symptoms. Hemangioma enhances peripherally first and fills centripetally, without a true scar.

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.