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The key point for liver tumors is that the NBME focuses on two main entities:

First, they want you to know about Focal Nodular Hyperplasia (FNH). A liver mass with a central scar found incidentally on CT is highly suggestive of FNH, which is a benign condition. To confirm the diagnosis non-invasively, the appropriate next step is a multiphase MRI of the liver, as biopsy is generally avoided because of the bleeding risk and the high accuracy of modern imaging [1].

Secondly, in the context of embryonal tumors in children, the NBME emphasizes hepatoblastoma. This is particularly important in patients with Beckwith-Wiedemann syndrome (BWS), characterized by features like macrosomia, macroglossia, and hemihypertrophy. In a patient with BWS who presents with a firm right upper quadrant mass and a markedly elevated alpha-fetoprotein (AFP) level, hepatoblastoma is highly suspected [3].

What's important to remember is that FNH is a benign liver lesion typically found incidentally in adults, while hepatoblastoma is a malignant tumor usually occurring in pediatric patients with certain syndromes like BWS. This distinction is high yield because it helps you approach liver masses appropriately based on the clinical context.