Abdominal and GI imaging: fibrolamellar carcinoma: practice question

A Radiology 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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Radiology · Abdominal and GI imaging: fibrolamellar carcinoma

Sample item

A 20-year-old has a large liver mass with normal alpha-fetoprotein, a central calcified scar that is T2 hypointense, and enlarged porta hepatis nodes. There is no cirrhosis. What is the most likely diagnosis?

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

The answer and the reasoning

D. Fibrolamellar hepatocellular carcinoma

Fibrolamellar carcinoma arises in young adults without cirrhosis and usually has normal AFP. The central scar is calcified and T2 hypointense, unlike FNH, and nodal spread is common.

Option by option

  • A. Hepatic adenoma

    An adenoma is a haemorrhage-prone mass in women on oral contraceptives, without a central scar.

  • B. Focal nodular hyperplasia

    FNH has a T2-bright central scar that enhances on delayed images and never causes nodal disease.

  • C. Cavernous haemangioma

    A cavernous haemangioma shows peripheral nodular enhancement with centripetal filling.

  • D. Fibrolamellar hepatocellular carcinoma (correct)

    Correct. A T2-dark calcified scar in a large mass in a young non-cirrhotic patient points to fibrolamellar 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 Radiology question

What is the answer to this Radiology question?

The best answer is D, Fibrolamellar hepatocellular carcinoma. Fibrolamellar carcinoma arises in young adults without cirrhosis and usually has normal AFP.

Why is "Hepatic adenoma" not the answer?

An adenoma is a haemorrhage-prone mass in women on oral contraceptives, without a central scar.

Why is "Focal nodular hyperplasia" not the answer?

FNH has a T2-bright central scar that enhances on delayed images and never causes nodal disease.

Why is "Cavernous haemangioma" not the answer?

A cavernous haemangioma shows peripheral nodular enhancement with centripetal filling.

What concept does this question test?

It tests Abdominal and GI imaging: fibrolamellar carcinoma in Radiology. The central scar is calcified and T2 hypointense, unlike FNH, and nodal spread is common.

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 Abdominal and GI imaging: fibrolamellar carcinoma?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology 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.