A 28-year-old woman has an incidentally detected 4 cm left lobe liver lesion. MRI shows a lobulated mass that is isointense to liver with a central T2 hyperintense scar, and on hepatocyte-specific contrast phase the entire lesion retains contrast homogeneously except the scar. The most likely diagnosis and appropriate action are:

• A Hepatic adenoma, resection advised
• B Fibrolamellar hepatocellular carcinoma, major hepatectomy
• C Focal nodular hyperplasia, no treatment required ✓
• D Cavernous haemangioma, embolization

Explanation

The central fibrous scar with homogeneous uptake of hepatocyte-specific contrast is characteristic of focal nodular hyperplasia, a hyperplastic response to a congenital arteriovenous malformation. FNH has essentially no malignant potential and does not bleed, so it requires neither resection nor restriction of oral contraceptives. Adenoma lacks a central scar and typically shows heterogeneous enhancement with washout, which distinguishes it here.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.