A 32-year-old woman has a 6 cm right lobe lesion found incidentally. MRI shows homogeneous arterial enhancement with a central star-shaped area of T2 hyperintensity that enhances late, no capsule, and no washout. She has never taken oral contraceptives and AFP is normal. The most likely diagnosis is:

• A Hepatic adenoma
• B Focal nodular hyperplasia ✓
• C Fibrolamellar hepatocellular carcinoma
• D Cavernous hemangioma

Explanation

Focal nodular hyperplasia is a hyperplastic response to a congenital arteriovenous malformation, and its hallmark is the central stellate scar with radiating fibrous bands containing thick-walled vessels, seen here as delayed-enhancing central T2 signal. Unlike hepatic adenoma, it is unrelated to oral contraceptives, carries essentially no risk of hemorrhage or malignant transformation, and needs no resection. Fibrolamellar carcinoma occurs in the same age group but shows raised AFP in half the cases and a lobulated heterogeneous mass. Hemangioma shows peripheral puddling, not a central scar.

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.