True regarding Hepatocellular carcinoma (HCC) is:

Ans: A (NASH is a risk factor) Ref: Robbins Pathologic Basis of Disease, 8th edition.Explanation:Hepatocellular Carcinoma (HCC)Increasing incidence, mainly due to HCV and HBV chronic infection.Male predominance (2.4 : 1)PathogenesisFour major etiologic factors associated with HCC have been established:Chronic viral infection (HBV, HCV)Chronic alcoholismNon-alcoholic steatohepatitis (NASH)Food contaminants (primarily aflatoxins produced by Aspergillus flavus)Other conditions includeTyrosinemiaGlycogen storage diseaseHereditary hemochromatosisNon-alcoholic fatty liver diseasea1-antitrypsin deficiencyThe precise mechanisms of carcinogenesis are unknown.Progression to HCC might result from point mutations in selected cellular genes such as KRAS and p53. and constitutive expression of c-MYC, c-MET (the receptor for hepatocyte growth factor). TGF-a, and insulin-like growth factor 2.Recent global gene expression studies revealed that approximately 50% of HCC cases are associated with activation of VVNT or AKT pathways.MorphologyHCC may appear grossly asUnifocal (usually large) massMultifocal, widely distributed nodules of variable sizeDiffusely infiltrative cancerAll patterns of HCCs have a strong propensity for invasion of vascular structures.Extensive intrahepatic metastases ensue, and occasionally, long* snakelike masses of tumor invade the portal vein (with occlusion of the portal circulation) or inferior vena cava, extending even into the right side of the heart.HCC spreads extensively within the liver by obvious contiguous growth and by the development of satellite nodules, which can be shown by molecular methods to be derived from the parent tumor.Metastasis outside the liver is primarily via vascular invasion, especially into the hepatic vein system, but hematogenous metastases, especially to the lung, tend to occur late in the disease.