Systemic pathology: focal nodular hyperplasia: practice question

A Pathology 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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Pathology · Systemic pathology: focal nodular hyperplasia

Sample item

A 30-year-old woman has an asymptomatic liver mass found incidentally on ultrasound. The resected, unencapsulated lesion shows a central stellate scar with radiating fibrous septa containing thick-walled vessels and bile ductular proliferation. Hepatocytes are bland and AFP is normal. What is the diagnosis?

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

The answer and the reasoning

D. Focal nodular hyperplasia

Focal nodular hyperplasia is a regenerative response to an abnormal arterial supply. Its central scar with ductular reaction and benign hepatocytes distinguishes it from adenoma, which lacks portal tracts and bile ducts, and from fibrolamellar carcinoma, which has atypical cells.

Option by option

  • A. Fibrolamellar carcinoma

    Fibrolamellar carcinoma has large pleomorphic eosinophilic cells in lamellar fibrous bands.

  • B. Hepatocellular adenoma

    Hepatocellular adenoma lacks bile ducts and a scar, and is prone to haemorrhage, especially with oral contraceptives.

  • C. Cavernous haemangioma

    Cavernous haemangioma consists of blood-filled vascular channels, not hepatocytes with a scar.

  • D. Focal nodular hyperplasia (correct)

    Correct. A central scar with ductular proliferation and bland hepatocytes is typical of focal nodular hyperplasia.

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 Pathology question

What is the answer to this Pathology question?

The best answer is D, Focal nodular hyperplasia. Focal nodular hyperplasia is a regenerative response to an abnormal arterial supply.

Why is "Fibrolamellar carcinoma" not the answer?

Fibrolamellar carcinoma has large pleomorphic eosinophilic cells in lamellar fibrous bands.

Why is "Hepatocellular adenoma" not the answer?

Hepatocellular adenoma lacks bile ducts and a scar, and is prone to haemorrhage, especially with oral contraceptives.

Why is "Cavernous haemangioma" not the answer?

Cavernous haemangioma consists of blood-filled vascular channels, not hepatocytes with a scar.

What concept does this question test?

It tests Systemic pathology: focal nodular hyperplasia in Pathology. Its central scar with ductular reaction and benign hepatocytes distinguishes it from adenoma, which lacks portal tracts and bile ducts, and from fibrolamellar carcinoma, which has atypical cells.

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 Systemic pathology: focal nodular hyperplasia?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology 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.