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Hepatocellular carcinomas are the most common primary neoplasia of the liver. The global distribution of hepatocellular carcinoma is related to the prevalence of hepatitis C in the population. Other major etiologic factors include alcoholic liver disease and nonalcoholic steatohepatitis. The majority of cases are discovered when screening patients with either chronic hepatitis or cirrhosis, but occasional incidental cases have been reported. Molecular markers and associated gene alterations are a work in progress. Serological markers and radiology are used to detect the disease in high-risk populations, and to monitor response to therapy in the affected patients. Even though radiologic features are specific, tissue diagnosis may be required, particularly for atypical and smaller lesions. Ancillary studies including reticulin stain and immunohistochemistry are important for confirmatory diagnosis. Liver transplantation is curative for hepatocellular carcinoma, but due to limitations in organ availability, palliative care is required, which mostly includes chemoembolization and radio-ablation.
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