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Focal Nodular Hyperplasia — RACP Adult Medicine MCQ

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ModerateGastroenterologyFocal Nodular HyperplasiaRACP Adult Medicine

A 30-year-old woman on the OCP has an incidental 5 cm well-defined hyperechoic liver mass on ultrasound. She is asymptomatic. AFP is normal. Contrast CT shows arterial enhancement with centripetal filling (from periphery to centre). MRI shows T2 hyperintensity with a central scar that enhances late. What is the most likely diagnosis?

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Correct answer: A — Focal nodular hyperplasia

A well-defined liver mass in a young woman on OCP with central scar enhancing late on MRI and arterial enhancement with spoke-wheel pattern is focal nodular hyperplasia (FNH). FNH is the second most common benign liver tumour. The central scar with late enhancement (fibrotic scar) is pathognomonic on MRI. FNH does NOT require treatment or cessation of OCP (unlike hepatocellular adenoma). No malignant potential. Biopsy is rarely needed if imaging is characteristic.

Reference: EASL – 2024 – Benign Liver Lesions; eTG GI 2024