A 29-year-old woman has a 4 cm liver lesion found incidentally on ultrasound. MRI shows homogeneous arterial enhancement centred on a non-enhancing stellate area, with the lesion becoming isointense to liver on delayed images. She takes no medications. Serum AFP and CA 19-9 are normal. The most appropriate management is:
- A Laparoscopic left lateral segmentectomy
- B Percutaneous core biopsy for confirmation
- C Reassurance and no follow-up imaging required ✓
- D Serial alpha-fetoprotein measurement every 3 months
Explanation
The central stellate scar with homogeneous arterial enhancement is characteristic of focal nodular hyperplasia, a hyperplastic response to a congenital arterioportal malformation rather than a true neoplasm. FNH has no malignant potential, essentially never bleeds, and requires no treatment or routine surveillance once confidently diagnosed radiologically. Biopsy is unnecessary and risks bleeding. Resection is reserved for symptomatic large lesions or genuine diagnostic uncertainty. AFP surveillance addresses hepatocellular carcinoma, a different entity occurring against cirrhosis, not this lesion.
Reference: Blumgart's Surgery of the Liver, Biliary Tract and Pancreas, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.