Clinical Presentation

A 35-year-old woman presents with right upper quadrant pain. Her α-fetoprotein level is normal.

(A) Infused abdominal computed tomography (CT) shows a well-circumscribed, heterogeneous hepatic mass (arrows) that is hypodense to liver parenchyma and obstructs the intrahepatic bile ducts (arrowhead).(B) More caudal image shows the mass to be quite large, with a lobulated contour (large arrow), a dense capsule (small arrow), and a hypodense, radiating central region (arrowhead).

Differential Diagnosis

• Fibrolamellar carcinoma (FLC): This top choice is suggested by a large, encapsulated mass with a hypodense central scar on delayed imaging and a lobulated contour in a young patient. The α-fetoprotein level is typically normal, as in this case.

• Hepatic adenoma: