HCC

Fibrolamellar carcinoma of the liver

by
Fibrolamellar Carcinoma Liver MCQ |

Fibrolamellar Carcinoma Liver MCQ – Young Female Liver Tumor

📘 Theme: Liver Tumors – Hepatobiliary Surgery (NEET SS / INI-CET High Yield)

Fibrolamellar Carcinoma MCQ

Which of the following statements regarding fibrolamellar carcinoma of the liver is correct?

A. Occurs in the setting of cirrhosis
B. Has worse survival than hepatocellular carcinoma
C. Can be followed up for long time
D. Seen in young females

Answer: D. Seen in young females

Explanation

Fibrolamellar carcinoma (FLC) is a rare variant of hepatocellular carcinoma that typically affects adolescents and young adults, often females, without underlying cirrhosis or chronic liver disease. Unlike conventional HCC, AFP is usually normal or only mildly elevated.

Histologically, it is characterized by large eosinophilic tumor cells separated by dense lamellar fibrosis.

Why other options are incorrect

  • Occurs in the setting of cirrhosis: False. FLC usually arises in non-cirrhotic livers.
  • Has worse survival than hepatocellular carcinoma: False. Fibrolamellar carcinoma generally has better survival than conventional HCC because patients are younger and liver function is preserved.
  • Can be followed up for long time: False. Surgical resection is the treatment of choice because the tumor has malignant potential.

High-yield teaching points

  • Young patient + liver mass + no cirrhosis = think fibrolamellar carcinoma.
  • AFP is often normal in fibrolamellar carcinoma.
  • Central scar may mimic focal nodular hyperplasia on imaging.
  • Best treatment is aggressive surgical resection.

Practice More Surgery MCQs

HCC Cancer

by

Q) Which of the following is true about screening in hepatocellular carcinoma (HCC Cancer) 

a) Alpha feto protein should be done 6 monthly

b) Ultrasound abdomen should be done 6 monthly

c) Candidates for liver transplant should be screened every 3 months

d) Nodules more than 2 cm should be followed up  more regularly

Answer b

Cirrhosis is prone for development of HCC. Screening has to be stringent.  Earlier ultrasound of liver and alpha feto protein were both used for screening

In 2009 Marrero et al demonstrated the suboptimal accuracy of AFP and after that it has been removed from the screening protocol and now only ultrasound is being done.

The screening recommendation is not for those patients with severe associated conditions and with advanced liver disease who are already considered for  transplant. So there is no screening for those who are already listed. Nodules more than 1 cm are highly suspicious where as in nodules less than 1 cm only 40% will be malignant.

Ref: blumgart 6th edition

 

 

Copyrite. Mcqsurgery 2025