Histology USMLE Step 1 Practice Question
A 52-year-old man with a 10-year history of hepatitis B cirrhosis presents with right upper quadrant pain and weight loss. Vital signs are stable. Serum alpha-fetoprotein is 520 ng/mL. Contrast-enhanced CT shows a 3.5-cm arterially enhancing lesion in the right hepatic lobe with delayed washout. Liver biopsy is performed. Microscopic examination reveals loss of normal lobular architecture with sheets of polygonal hepatocytes displaying moderate nuclear pleomorphism, increased nuclear-to-cytoplasmic ratio, and 8 mitotic figures per 10 high-power fields. Immunohistochemistry shows diffuse glypican-3 positivity and retained reticulin framework at the lesion periphery. Which histologic finding is most consistent with hepatocellular carcinoma?
Answer choices
- ASpindle cell morphology with herringbone pattern arrangement and prominent hemangiopericytoma vasculature
- BCystic spaces lined by mucin-producing cuboidal epithelium with intraluminal papillae
- CSheets of atypical cells with loss of normal parenchymal architecture and increased mitotic activityCorrect answer
- DTall columnar cells with marked mucin production arranged in cribriform glandular patterns
- EBile duct hyperplasia with surrounding desmoplastic stroma and perineural invasion
- FSmall round blue cells with high nuclear-to-cytoplasmic ratio arranged in trabecular cords
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