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.
Hepatic Hemangioma Management MCQ for NEET SS | mcqsurgery.com
A 38-year-old woman is found to have a 12-cm hepatic hemangioma. Which statement regarding management is true?
Correct Answer
d) If surgery is planned, peripherally located hemangiomas should be enucleated
Explanation
Hepatic hemangiomas are the most common benign tumors of the liver and are usually detected incidentally.
Management depends on symptoms, complications, and diagnostic certainty, not size alone.
Size and surgery:
Lesion size alone, even when greater than 10 cm (giant hemangioma), is not an indication for surgery if the patient is asymptomatic.
Oral contraceptives and pregnancy:
Although estrogen exposure may cause hemangioma enlargement, there is no strong evidence that oral contraceptive pills or pregnancy significantly increase the risk of rupture. Routine avoidance is not recommended.
Role of arterial embolization:
Arterial embolization is not performed routinely. It is reserved for:
Symptomatic patients unfit for surgery
Acute bleeding
Preoperative reduction of tumor vascularity
Surgical technique:
When surgery is indicated (symptoms, complications, or diagnostic uncertainty), enucleation is preferred for peripherally located hemangiomas because it:
Preserves maximum liver parenchyma
Results in less blood loss
Has lower morbidity compared to formal hepatic resection
Teaching Points
Hepatic hemangioma is the most common benign liver tumor
Size alone is not an indication for surgery
Most asymptomatic hemangiomas require only observation
Enucleation is preferred over resection when surgery is needed
Embolization is reserved for selected symptomatic or high-risk cases
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.