Neoplasia: fibrolamellar 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 · Neoplasia: fibrolamellar carcinoma

Sample item

A 19-year-old woman has an abdominal mass. She has no cirrhosis or viral hepatitis, and serum AFP is normal. CT shows a large lobulated liver mass with a central scar. Histology shows large polygonal eosinophilic cells with prominent nucleoli lying between parallel bands of collagen. What is the diagnosis?

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

The answer and the reasoning

C. Fibrolamellar hepatocellular carcinoma

Fibrolamellar carcinoma is a variant of hepatocellular carcinoma seen in adolescents and young adults without cirrhosis or hepatitis, typically with a normal AFP. It has oncocytic cells in lamellar fibrosis and a DNAJB1-PRKACA fusion, and the prognosis is better than for usual hepatocellular carcinoma if resectable. Focal nodular hyperplasia also has a central scar but is benign and shows no cytological atypia.

Option by option

  • A. Focal nodular hyperplasia

    Focal nodular hyperplasia has bland hepatocytes with bile ductular proliferation in the scar and no atypia.

  • B. Hepatocellular adenoma

    Hepatocellular adenoma is linked to oral contraceptives and bleeds, but lacks lamellar fibrosis and atypia.

  • C. Fibrolamellar hepatocellular carcinoma (correct)

    Oncocytic atypical cells in lamellar fibrosis in a young non-cirrhotic liver define fibrolamellar carcinoma.

  • D. Hepatoblastoma

    Hepatoblastoma occurs in infants and young children and has raised AFP and fetal or embryonal elements.

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.

More Pathology questions

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is C, Fibrolamellar hepatocellular carcinoma. Fibrolamellar carcinoma is a variant of hepatocellular carcinoma seen in adolescents and young adults without cirrhosis or hepatitis, typically with a normal AFP.

Why is "Focal nodular hyperplasia" not the answer?

Focal nodular hyperplasia has bland hepatocytes with bile ductular proliferation in the scar and no atypia.

Why is "Hepatocellular adenoma" not the answer?

Hepatocellular adenoma is linked to oral contraceptives and bleeds, but lacks lamellar fibrosis and atypia.

Why is "Hepatoblastoma" not the answer?

Hepatoblastoma occurs in infants and young children and has raised AFP and fetal or embryonal elements.

What concept does this question test?

It tests Neoplasia: fibrolamellar carcinoma in Pathology. It has oncocytic cells in lamellar fibrosis and a DNAJB1-PRKACA fusion, and the prognosis is better than for usual hepatocellular carcinoma if resectable. Focal nodular hyperplasia also has a central scar but is benign and shows no cytological atypia.

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 Neoplasia: fibrolamellar 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.