Liver

Fibrolamellar carcinoma of the liver

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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.

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Hemangioma Liver

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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
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HCC Surveillance in High-Risk Patients – Clinical MCQ

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HCC Surveillance and Screening MCQ | NEET SS Surgery | MCQSurgery

Hepatocellular Carcinoma Surveillance – Clinical MCQ

High-Yield Liver MCQ for NEET SS, MCh and GI Surgery
LIVER • HEPATOCELLULAR CARCINOMA
Which of the following is true regarding surveillance for hepatocellular carcinoma (HCC)?
A. Serum alpha-fetoprotein (AFP) alone should be performed every 6 months
B. Abdominal ultrasound should be performed every 6 months
C. All candidates awaiting liver transplantation should undergo HCC surveillance every 3 months
D. Hepatic nodules larger than 2 cm should simply be followed up more frequently
✓ Correct Answer: B. Abdominal ultrasound should be performed every 6 months
Explanation

Surveillance for hepatocellular carcinoma is performed in patients at increased risk of developing HCC, particularly those with cirrhosis and selected patients with chronic hepatitis B infection.

Ultrasound-based surveillance at approximately 6-month intervals is the standard approach. Serum AFP may be used as an adjunct depending on the guideline and clinical setting, but AFP alone is not considered an adequate surveillance strategy.

Why are the other options wrong?

A. AFP alone every 6 months – Incorrect.
AFP has limited sensitivity and specificity. It should not be relied upon as the sole surveillance modality for HCC.

C. All transplant candidates every 3 months – Incorrect.
More frequent surveillance is not routinely required for every patient awaiting liver transplantation. The surveillance interval may vary according to individual clinical circumstances and the presence of known lesions.

D. Nodules larger than 2 cm should simply be followed more frequently – Incorrect.
A liver lesion larger than 2 cm requires appropriate diagnostic evaluation, usually with multiphasic contrast-enhanced imaging, rather than merely more frequent surveillance.

Teaching Point:

The key interval to remember for HCC surveillance is 6 months. Ultrasound is the cornerstone of surveillance, while AFP may be used as an additional tool depending on the clinical protocol.
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