Hepatobiliary and pancreatic surgery: fibrolamellar carcinoma: practice question

A General Surgery 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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General Surgery · Hepatobiliary and pancreatic surgery: fibrolamellar carcinoma

Sample item

A 22-year-old woman with no liver disease has a 12 cm liver mass with a central scar and calcification. Alpha-fetoprotein is normal. Histology shows large polygonal eosinophilic malignant cells separated by dense bands of collagen. What is the diagnosis?

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

The answer and the reasoning

D. Fibrolamellar hepatocellular carcinoma

Fibrolamellar carcinoma occurs in young adults without cirrhosis or hepatitis. It has a central scar that may calcify, a normal alpha-fetoprotein, and large eosinophilic cells in collagen bands. Resection offers the best outcome. Focal nodular hyperplasia also has a central scar but is benign and lacks malignant cells.

Option by option

  • A. Hepatocellular adenoma

    Adenoma shows bland hepatocytes without a scar and is linked to oral contraceptives.

  • B. Focal nodular hyperplasia

    Focal nodular hyperplasia is benign and shows bland hepatocytes with a stellate scar.

  • C. Hepatoblastoma

    Hepatoblastoma is a tumour of early childhood with raised alpha-fetoprotein.

  • D. Fibrolamellar hepatocellular carcinoma (correct)

    Correct. The setting, imaging and histology fit this variant of hepatocellular carcinoma.

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 General Surgery question

What is the answer to this General Surgery question?

The best answer is D, Fibrolamellar hepatocellular carcinoma. Fibrolamellar carcinoma occurs in young adults without cirrhosis or hepatitis.

Why is "Hepatocellular adenoma" not the answer?

Adenoma shows bland hepatocytes without a scar and is linked to oral contraceptives.

Why is "Focal nodular hyperplasia" not the answer?

Focal nodular hyperplasia is benign and shows bland hepatocytes with a stellate scar.

Why is "Hepatoblastoma" not the answer?

Hepatoblastoma is a tumour of early childhood with raised alpha-fetoprotein.

What concept does this question test?

It tests Hepatobiliary and pancreatic surgery: fibrolamellar carcinoma in General Surgery. It has a central scar that may calcify, a normal alpha-fetoprotein, and large eosinophilic cells in collagen bands. Resection offers the best outcome. Focal nodular hyperplasia also has a central scar but is benign and lacks malignant cells.

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 Hepatobiliary and pancreatic surgery: fibrolamellar carcinoma?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery 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.