A 38-year-old woman has a 5 cm hepatic lesion found incidentally. MRI shows T1 hypointensity, T2 hyperintensity, and strong arterial enhancement with rapid washout. Serum AFP is 1200 ng/mL. She is on oral contraceptives and has no cirrhosis. The most likely diagnosis is:

• A Hepatic adenoma
• B Hepatocellular carcinoma on non-cirrhotic liver ✓
• C Focal nodular hyperplasia
• D Hepatic haemangioma

Explanation

While hepatic adenoma is associated with OCP use, the markedly elevated AFP (1200 ng/mL), arterial enhancement with washout on MRI, and size >4 cm strongly favor hepatocellular carcinoma (HCC). HCC can arise in non-cirrhotic livers (10-20% of cases), particularly in patients with chronic HBV, fatty liver disease, or rarely in young women with underlying metabolic conditions. AFP >400 ng/mL with characteristic imaging (arterial enhancement + venous washout) is considered diagnostic for HCC in the appropriate clinical context.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.