Ramu, 40 year old male, chronic alcoholic, diagnosed as cirrhosis, presents with a lump in the right lobe of liver. Serum AFP level is normal. Most probable diagnosis is

This is a typical presentation of hepatocellular carcinoma (age, cirrhosis, presence of lump, all perfectly match.) The only problem is that AFP is not elevated. This should not prevent us from making a diagnosis of HCC as Schwaz writes-"It must be kept in mind that only 60 to 75% of HCCs produce AFP; therefore, a normal serum AFP level does not rule out HCC." Hepatocellular adenoma and focal nodular hyperplasia (I' could not find any term as Fibrohyperplasia) are seen in women of reproductive age gp. They are associated with OCPs. Ref : Schwaz 9/e, p 1110