A 35-year-old woman undergoes abdominal imaging for nonspecific right upper quadrant pain. A liver mass is identified and surgically excised. The gross specimen is shown. What is the most likely diagnosis?
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Benign liver mass with central stellate scar = focal nodular hyperplasia.
Step 1: Understanding the Question:
The question presents a gross surgical specimen of a liver mass in a young woman. The visual appearance of the mass provides the primary diagnostic clue. Step 2: Detailed Explanation:
Focal Nodular Hyperplasia (FNH): This is a benign, non-neoplastic liver lesion. It is more common in women. It is thought to be a hyperplastic response to a localized vascular malformation.
The "Central Scar": The pathognomonic gross finding for FNH is a well-circumscribed mass with a characteristic central stellate (star-shaped) scar. This scar contains large, malformed arteries that radiate outward (spoke-wheel appearance on imaging).
Hepatic Adenoma: This is a benign tumor strongly linked to Oral Contraceptive Pill (OCP) use. Grossly, it is often yellow/tan and lacks a central scar. It carries a risk of rupture/bleeding.
HCC: Hepatocellular carcinoma usually occurs in the setting of cirrhosis or chronic hepatitis. It is typically variegated, necrotic, and lacks the organized central scar of FNH.
Metastasis: These are often multiple, umbilicated, and firm, rather than a solitary mass with an organized scar.
Step 3: Final Answer:
The presence of a solitary liver mass with a prominent central stellate scar in a young woman is diagnostic of Focal Nodular Hyperplasia.
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