<prompt> True regarding Hepatocellular carcinoma HCC is:NASH is a risk factorOCPs are implicatedFocal Nodular Hyperplasia is premalignantChromosomal abnormalities are seen  <response>: Ans: A NASH is a risk factor Ref: Robbins Pathologic Basis of Disease, 8th edition.Explanation:Hepatocellular Carcinoma HCCIncreasing incidence, mainly due to HCV and HBV chronic infection.Male predominance 2.4 : 1PathogenesisFour major etiologic factors associated with HCC have been established:Chronic viral infection HBV, HCVChronic alcoholismNon-alcoholic steatohepatitis NASHFood contaminants primarily aflatoxins produced by Aspergillus flavusOther 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. 