Hepatic pathology: hepatocellular carcinoma: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Hepatic pathology: hepatocellular carcinoma

Sample item

A 58-year-old hepatitis B carrier with cirrhosis has a new 6 cm liver mass and an alpha-fetoprotein of 2400 ng/mL. Contrast CT is likely to show which pattern, allowing diagnosis without biopsy?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Arterial phase hyperenhancement with washout in the portal venous phase

Hepatocellular carcinoma in cirrhosis receives blood mainly from new hepatic arterial vessels, while normal liver is supplied by portal venous blood. The tumour therefore enhances brightly in the arterial phase and washes out later as portal contrast leaves it. This classic pattern, with a high AFP, is diagnostic in a cirrhotic patient.

Option by option

  • A. Hypovascular lesion with a central stellate scar and no enhancement

    A central stellate scar suggests focal nodular hyperplasia or fibrolamellar carcinoma in a non-cirrhotic liver.

  • B. Peripheral nodular enhancement with progressive centripetal fill-in

    Peripheral nodular enhancement with centripetal fill-in is typical of a haemangioma.

  • C. Rim enhancement with a non-enhancing central cystic cavity only

    A rim-enhancing cystic cavity suggests an abscess and not a solid tumour with high AFP.

  • D. Arterial phase hyperenhancement with washout in the portal venous phase (correct)

    Correct. Arterial supply from neoangiogenesis gives arterial enhancement and washout.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is D, Arterial phase hyperenhancement with washout in the portal venous phase. Hepatocellular carcinoma in cirrhosis receives blood mainly from new hepatic arterial vessels, while normal liver is supplied by portal venous blood.

Why is "Hypovascular lesion with a central stellate scar and no enhancement" not the answer?

A central stellate scar suggests focal nodular hyperplasia or fibrolamellar carcinoma in a non-cirrhotic liver.

Why is "Peripheral nodular enhancement with progressive centripetal fill-in" not the answer?

Peripheral nodular enhancement with centripetal fill-in is typical of a haemangioma.

Why is "Rim enhancement with a non-enhancing central cystic cavity only" not the answer?

A rim-enhancing cystic cavity suggests an abscess and not a solid tumour with high AFP.

What concept does this question test?

It tests Hepatic pathology: hepatocellular carcinoma in Pathology. The tumour therefore enhances brightly in the arterial phase and washes out later as portal contrast leaves it. This classic pattern, with a high AFP, is diagnostic in a cirrhotic patient.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Hepatic pathology: hepatocellular carcinoma?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.