Liver: transplant criteria for HCC: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Liver: transplant criteria for HCC

Sample item

Four cirrhotic patients with hepatocellular carcinoma and no vascular invasion or extrahepatic spread are assessed for liver transplantation. Which tumour burden falls within the Milan criteria?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Three nodules measuring 2.8, 2.5 and 2.0 cm

The Milan criteria allow transplantation for a single tumour up to 5 cm, or up to three tumours none larger than 3 cm, with no macrovascular invasion and no extrahepatic disease. Selecting patients this way gives post-transplant survival comparable to that for non-malignant indications. Here three nodules all within 3 cm qualify.

Option by option

  • A. Two nodules of 4 cm and 3.5 cm

    Two nodules where one exceeds 3 cm do not satisfy the multiple-nodule criterion.

  • B. Four nodules of 2 cm each

    Four tumours exceed the maximum of three nodules, even though each is small.

  • C. Three nodules measuring 2.8, 2.5 and 2.0 cm (correct)

    Correct. Up to three nodules, each no larger than 3 cm, meet the Milan criteria.

  • D. A single nodule of 6 cm

    A single 6 cm tumour exceeds the 5 cm limit for a solitary lesion.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is C, Three nodules measuring 2.8, 2.5 and 2.0 cm. The Milan criteria allow transplantation for a single tumour up to 5 cm, or up to three tumours none larger than 3 cm, with no macrovascular invasion and no extrahepatic disease.

Why is "Two nodules of 4 cm and 3.5 cm" not the answer?

Two nodules where one exceeds 3 cm do not satisfy the multiple-nodule criterion.

Why is "Four nodules of 2 cm each" not the answer?

Four tumours exceed the maximum of three nodules, even though each is small.

Why is "A single nodule of 6 cm" not the answer?

A single 6 cm tumour exceeds the 5 cm limit for a solitary lesion.

What concept does this question test?

It tests Liver: transplant criteria for HCC in General Surgery. Selecting patients this way gives post-transplant survival comparable to that for non-malignant indications. Here three nodules all within 3 cm qualify.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Liver: transplant criteria for HCC?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.