A patient with hepatocellular carcinoma (HCC) is evaluated for liver transplantation. He has two lesions: 4.5 cm and 2.8 cm, with AFP 450 ng/mL, no vascular invasion, and no extrahepatic disease. According to the Milan criteria, is he eligible for transplantation?
- A Yes — Milan criteria allow up to 3 nodules each ≤3 cm or a single nodule ≤5 cm
- B Yes — Milan criteria allow any number of lesions as long as total tumour volume is <115 cm³
- C No — Milan criteria allow one nodule ≤5 cm OR up to three nodules each ≤3 cm; two nodules where the largest is 4.5 cm exceeds criteria ✓
- D No — AFP >400 ng/mL alone excludes transplantation regardless of tumour size
Correct answer: C. No — Milan criteria allow one nodule ≤5 cm OR up to three nodules each ≤3 cm; two nodules where the largest is 4.5 cm exceeds criteria
Explanation
Milan criteria: one HCC nodule ≤5 cm, OR up to three nodules each ≤3 cm, with no vascular invasion and no extrahepatic spread. This patient has two nodules (4.5 cm + 2.8 cm); the second criterion requires all nodules ≤3 cm, which the 4.5 cm lesion violates, making him ineligible under strict Milan criteria. The UCSF criteria (single ≤6.5 cm or ≤3 lesions all ≤4.5 cm with total ≤8 cm) would include him.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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