A 24-year-old woman presents with right upper quadrant discomfort. CT shows a 9 cm solid liver mass in a non-cirrhotic liver with a central fibrous scar. Serum AFP is 3 ng/mL. Wedge biopsy shows sheets of large oncocytic cells separated by lamellar fibrous bands. The best next step is:
- A Surgical resection, which offers excellent long-term survival ✓
- B Liver transplantation because recurrence after resection approaches 50 percent
- C Transarterial chemoembolization followed by sorafenib
- D Observation with serial AFP, since the lesion is a benign adenoma
Correct answer: A. Surgical resection, which offers excellent long-term survival
Explanation
The young age, non-cirrhotic liver, huge tumour, normal AFP and lamellar fibrosis on histology are classic for fibrolamellar hepatocellular carcinoma. Unlike conventional HCC it arises in healthy livers, metastasizes late, and resection achieves five-year survival around 60 to 70 percent, far better than age-matched conventional HCC. Observation would be fatal, and transplantation is reserved for unresectable disease.
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.