A 24-year-old woman presents with a 12 cm mass occupying the left lobe of the liver. She is otherwise well and has no stigmata of chronic liver disease. CT shows a heterogeneous tumour with a central stellate scar. Serum alpha-fetoprotein is 4 ng/mL and hepatitis serology is negative. The most likely diagnosis is:

• A Hepatocellular carcinoma complicating occult cirrhosis
• B Fibrolamellar hepatocellular carcinoma ✓
• C Focal nodular hyperplasia
• D Hepatic adenoma

Explanation

Fibrolamellar hepatocellular carcinoma occurs in adolescents and young adults without cirrhosis or viral hepatitis, typically as a large tumour with a central fibrous scar, and characteristically produces normal or minimally raised AFP. Focal nodular hyperplasia shares the central scar but is benign, rarely exceeds several centimetres with mass effect, and shows homogeneous enhancement with a non-enhancing scar rather than a malignant heterogeneity pattern.

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.