Hepatocellular carcinoma

Question: Which of the following risk factors is not associated with the development of hepatocellular carcinoma?

A. hepatitis B viral genotype

B. male gender


D. portal vein thrombosis


Answer: Hepatocellular carcinoma (HCC) arises in a cirrhotic liver in over 80% of cases.  Therefore, the presence of cirrhosis is the number one RF for developing this neoplasm, and biannual screening with AFP and US is recommended. 

As for individual risk factors, there are many.  Male gender is one.  An elevated alpha fetoprotein (AFP) is another, though it can be normal in greater than 1/3 of HCC cases.  The HVPG (hepatic vein / portal pressure gradient) has been positively correlated with the development of HCC.  Hepatitis B viral genotypes C and D (most commonly found in Asia) are correlated with HCC.

This leaves portal vein thrombosis (PVT), which by itself is not a risk factor for the development of HCC.  It could be a sign of underlying cirrhosis, however, and might prompt a staging workup.  You can think of a PVT as a pre-sinusoidal lesion.  It may prompt the development of venous collateral formation, but not the development of arterialization and promotion of HCC.

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