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Hepatocellular Carcinoma — RACP Adult Medicine MCQ

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EasyGastroenterology & HepatologyHepatocellular CarcinomaRACP Adult Medicine

A 60-year-old man with known hepatitis C cirrhosis undergoes surveillance ultrasound which reveals a 2.5 cm lesion in segment VI. His AFP is 380 µg/L. Contrast-enhanced CT shows arterial phase hyperenhancement with washout in the portal venous phase. What do these imaging features indicate?

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Correct answer: B — Hepatocellular carcinoma (HCC)

The combination of arterial phase hyperenhancement with washout in the portal venous/delayed phase in a cirrhotic liver is diagnostic of HCC by LI-RADS criteria (LR-5) and does not require biopsy confirmation. The elevated AFP supports the diagnosis. This patient should be discussed at a multidisciplinary meeting for treatment planning (resection, transplant, ablation, or TACE depending on liver function and tumour stage).

Reference: Cancer Council Australia – 2020 – Optimal Care Pathway for HCC; AASLD – 2023 – HCC Guidelines