Neoplasia USMLE Step 1 Practice Question
A 72-year-old man with a 15-year history of hepatitis C cirrhosis presents to clinic with right upper quadrant pain for 2 weeks. He denies fever, jaundice, or weight loss. Vital signs are within normal limits. Physical examination reveals hepatomegaly without stigmata of decompensation. Laboratory studies show AST 78 U/L, ALT 62 U/L, total bilirubin 1.1 mg/dL, albumin 3.5 g/dL, and alpha-fetoprotein 320 ng/mL. Multiphasic contrast-enhanced CT demonstrates a solitary 2.8-cm lesion in the right hepatic lobe with homogeneous arterial phase enhancement and washout in the portal venous phase. There is no evidence of extrahepatic disease. Based on the AASLD noninvasive diagnostic criteria, what is the most likely diagnosis?
Answer choices
- AHepatic hemangioma with incidental elevated alpha-fetoprotein from concurrent hepatic inflammation
- BIntrahepatic cholangiocarcinoma with atypical imaging characteristics requiring tissue diagnosis
- CHepatocellular carcinoma meeting diagnostic criteria in a cirrhotic patientCorrect answer
- DRegenerative nodule with dysplasia requiring follow-up imaging in 3 months
- EFocal nodular hyperplasia with portal venous hypertension masking typical enhancement pattern
- FHepatic adenoma with spontaneous hemorrhage explaining alpha-fetoprotein elevation
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