The Milan criteria define the selection of hepatocellular carcinoma (HCC) patients for liver transplantation. Which HCC burden exceeds the Milan criteria and therefore precludes standard transplant listing?
- A Single tumor 4 cm, AFP 120 ng/mL, no vascular invasion
- B Two tumors: 2 cm and 3 cm, no macrovascular invasion
- C Single tumor 5.5 cm with satellite nodule, no macrovascular invasion ✓
- D Three tumors each ≤2 cm, AFP 200 ng/mL
Correct answer: C. Single tumor 5.5 cm with satellite nodule, no macrovascular invasion
Explanation
The Milan criteria for liver transplantation in HCC are: single lesion ≤5 cm, or up to 3 lesions each ≤3 cm, with no macrovascular invasion and no extrahepatic disease. Option A (single 4 cm) meets Milan criteria (≤5 cm). Option B (two tumors, 2 cm and 3 cm) meets Milan criteria (up to 3 lesions, each ≤3 cm). Option C (5.5 cm single tumor = exceeds 5 cm limit) does NOT meet Milan criteria, even without vascular invasion—size alone exceeds the threshold. Option D (three tumors each ≤2 cm) meets Milan criteria.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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