Hepatocellular carcinoma - Quiz
Hepatocellular carcinoma
  • 1. What are the two main macroscopic appearances of hepatocellular carcinoma?
A) Cystic and solid
B) Encapsulated and diffused
C) Nodular and infiltrative
D) Fibrous and vascular
  • 2. What color might liver tumor nodules appear if they produce bile?
A) Yellow
B) Green
C) Red
D) Blue
  • 3. Which statement accurately describes the nodular type of hepatocellular carcinoma?
A) Poorly circumscribed and infiltrative
B) Exclusively solitary
C) Well circumscribed but not encapsulated
D) Completely encapsulated
  • 4. What structure is commonly infiltrated by the diffuse type of hepatocellular carcinoma?
A) Portal veins
B) Pancreatic duct
C) Gallbladder
D) Bile ducts
  • 5. How many architectural and cytological types of hepatocellular carcinoma are listed in the text?
A) Two
B) Four
C) Six
D) Five
  • 6. Which of the following is an architectural type of hepatocellular carcinoma?
A) Fibrolamellar
B) Small cell
C) Papillary
D) Squamous
  • 7. What do tumor cells resemble in well-differentiated forms of hepatocellular carcinoma?
A) Endothelial cells
B) Hepatocytes
C) Kupffer cells
D) Bile duct cells
  • 8. What patterns can tumor cells form in well-differentiated hepatocellular carcinoma?
A) Trabeculae, cords, and nests
B) Acini and tubules
C) Papillae and follicles
D) Sheets and clusters
  • 9. Why do poorly differentiated hepatocellular carcinomas often show central necrosis?
A) High lipid content
B) Poor vascularization
C) Rapid cell division
D) Bile accumulation
  • 10. What is the name of the fifth, less common form of hepatocellular carcinoma?
A) Hepatoblastoma-like carcinoma
B) Cholangiocarcinoma-like carcinoma
C) Sarcomatoid hepatocellular carcinoma
D) Lymphoepithelioma-like hepatocellular carcinoma
  • 11. How are malignant epithelial cells described in poorly differentiated forms?
A) Columnar, glandular, and well-defined
B) Uniform, cohesive, and small
C) Discohesive, pleomorphic, anaplastic, and giant
D) Cuboidal, organized, and encapsulated
  • 12. Which of the following describes the stroma of hepatocellular carcinoma?
A) Calcified
B) Fibrotic
C) Scant
D) Abundant
  • 13. When does the nodular type of hepatocellular carcinoma often appear as multiple masses?
A) After chemotherapy treatment
B) When the tumor is encapsulated
C) As a complication of cirrhosis
D) In the early stages of development
  • 14. Which of the following is a cytological type of hepatocellular carcinoma mentioned in the text?
A) Fatty cell
B) Clear cell
C) Large cell
D) Spindle cell
  • 15. What is the main characteristic of the diffuse type of hepatocellular carcinoma?
A) Poorly circumscribed
B) Encapsulated
C) Well circumscribed
D) Solitary nodule
  • 16. Which imaging modality is listed as having the potential to deliver high-resolution images without using ionizing radiation?
A) X-ray
B) MRI
C) CT scan
D) Ultrasound
  • 17. How many growth patterns of HCC are identified on CT and MRI?
A) Two
B) Four
C) Five
D) Three
  • 18. What is the sensitivity of CT diagnosis for HCC according to the systematic review mentioned?
A) 68%
B) 85%
C) 90%
D) 81%
  • 19. How does HCC typically appear on T1-weighted MRI images?
A) High-intensity pattern
B) Iso-intense pattern
C) Low-intensity pattern
D) Heterogeneous pattern
  • 20. What is the specific appearance of HCC on T2-weighted MRI images?
A) Variable intensity pattern
B) High-intensity pattern
C) Iso-intense pattern
D) Low-intensity pattern
  • 21. What is the acronym for the classification system used for reporting liver lesions?
A) HCC-RADS
B) LI-RADS
C) LIVER-CAT
D) LI-SCORE
  • 22. What happens to MRI sensitivity when gadolinium contrast-enhanced and diffusion-weighted imaging are combined?
A) It increases
B) It remains the same
C) It decreases
D) It becomes unreliable
  • 23. In which patient group does MRI offer an advantage in differentiating HCC from regenerative nodules?
A) Pediatric patients
B) Cirrhotic patients
C) Patients with fatty liver disease
D) Patients with liver trauma
  • 24. According to the text, what is the highest LI-RADS category mentioned?
A) 5
B) 6
C) 3
D) 4
  • 25. Is a biopsy always required to confirm the diagnosis of HCC?
A) Only in late stages
B) Yes, always
C) Only for small lesions
D) No, if imaging criteria are met
  • 26. What was the specificity of MRI for HCC based on the systematic review cited?
A) 90%
B) 68%
C) 85%
D) 93%
  • 27. What is the five-year survival rate for individuals diagnosed with HCC?
A) 5%
B) 18%
C) 50%
D) 35%
  • 28. Which population group has a higher incidence of HCC, being more than three times as common as the other?
A) Males
B) Elderly individuals
C) Children
D) Females
  • 29. What is currently the fastest growing cause of HCC?
A) Hemochromatosis
B) Hepatitis B
C) Alcohol use
D) NASH
  • 30. In the United States, the rising incidence of HCC is primarily linked to an increase in which virus?
A) Hepatitis A
B) Hepatitis D
C) Hepatitis B
D) Hepatitis C
  • 31. Globally, what is the estimated percentage of HCC cases caused by chronic viral hepatitis?
A) 25%
B) 80%
C) 10%
D) 50%
  • 32. Which type of hepatitis is responsible for about 50% of HCC cases globally?
A) Hepatitis C
B) Hepatitis A
C) Hepatitis B
D) Hepatitis E
  • 33. Which toxin is specifically mentioned as a risk factor for HCC?
A) Mercury
B) Lead
C) Arsenic
D) Aflatoxin
  • 34. What is the most common cause of cirrhosis?
A) Hepatitis C
B) Hemochromatosis
C) Diabetes
D) Alcohol use disorder
  • 35. What congenital disorder is known to markedly increase the risk of HCC?
A) Turner syndrome
B) Down syndrome
C) Alpha 1-antitrypsin deficiency
D) Cystic fibrosis
  • 36. HCC ranks as the leading cause of cancer-related deaths worldwide at which position?
A) Second
B) Third
C) Fifth
D) First
  • 37. What is the primary reason HCC is statistically associated with hemophilia?
A) High levels of iron in blood products
B) Genetic predisposition to liver tumors
C) Side effects of blood clotting medication
D) Coincident chronic viral hepatitis infection
  • 38. Which subtype of hepatic adenoma is particularly associated with an increased risk of HCC?
A) Beta-catenin activation mutation
B) Hepatocyte-only adenoma
C) Alpha-fetoprotein dominant
D) Fibrolamellar variant
  • 39. Which factor is suspected to contribute significantly to the increased risk of hepatocellular carcinoma in diabetics?
A) Type of carbohydrate consumption
B) Circulating insulin concentration
C) Physical activity level
D) Blood glucose stability
  • 40. What is a characteristic of diabetics who show risk levels for HCC indistinguishable from the general population?
A) High insulin output
B) Tight insulin control
C) Chronic high blood sugar
D) Exclusive use of anabolic steroids
  • 41. Besides type 2 diabetes, which condition is mentioned as having poor insulin regulation and increased HCC risk?
A) Type 1 diabetes
B) Chronic kidney disease
C) Metabolic syndrome
D) Hypertension
  • 42. What are the two main ways that cancer cells develop?
A) High glucose consumption or reduced bile flow
B) Viral integration or bile salt accumulation
C) Increased oxygen uptake or reduced liver size
D) Higher replication rate or avoiding apoptosis
  • 43. How do hepatitis B and C contribute to HCC pathogenesis?
A) By blocking the bile salt export pump
B) By increasing insulin production in the liver
C) By directly converting benign adenomas
D) By causing immune cells to attack liver cells
  • 44. What substances are released by activated immune-system inflammatory cells that cause DNA damage?
A) Bile salts
B) Free radicals
C) Insulin-like growth factors
D) Steroid hormones
  • 45. What percentage of HCC cases involve mutations in the TERT promoter?
A) 47–60%
B) 70–85%
C) 10–20%
D) 30–40%
  • 46. What is the result of TERT promoter mutations in HCC cells?
A) Reduced bile salt export
B) Decreased cell division
C) Increased apoptotic rate
D) Constitutively active telomerase
  • 47. What is the approximate prevalence of TP53 gene mutations in HCC cases?
A) 60%
B) 5%
C) 10%
D) 30%
  • 48. Which signaling pathway, commonly mutated in HCC, is responsible for embryogenesis and cell homeostasis?
A) Wnt
B) TERT
C) TP53
D) ABCB11
  • 49. A deficiency in which gene leads to the toxic accumulation of bile salts?
A) AXIN1
B) CTNNB1
C) TP53
D) ABCB11
  • 50. What was historically required to prove an HCC diagnosis?
A) Biopsy
B) Physical examination
C) Genetic screening
D) Blood testing
  • 51. Which mutations are seen in 10% of HCC cases regarding chromatin remodeling?
A) AXIN1
B) ARID1A
C) CTNNB1
D) ABCB11
  • 52. What is the recommended interval for ultrasound screening for HCC in patients with cirrhosis according to the AASLD?
A) Every three months
B) Every six months
C) Every twelve months
D) Every eighteen months
  • 53. What is the sensitivity of AFP at levels greater than 20?
A) 99%
B) 41–65%
C) 31%
D) 80–94%
  • 54. What is the specificity of AFP at levels greater than 200?
A) 41–65%
B) 99%
C) 31%
D) 80–94%
  • 55. When combined with AFP correlation, what does the sensitivity of ultrasound for HCC detection increase to?
A) 60%
B) 41%
C) 79%
D) 97%
  • 56. What primary imaging modality is recommended for routine HCC screening in high-risk populations?
A) CT scan
B) MRI
C) Ultrasound
D) PET scan
  • 57. What is the specificity of ultrasound for HCC based on a systematic review compared to pathologic examination?
A) 97%
B) 60%
C) 31%
D) 79%
  • 58. What technique is used during CT or MRI to improve detection and classification of liver lesions?
A) Intravenous contrast in multiple phases
B) Oral contrast agents
C) Low-dose radiation scanning
D) Sedation-free imaging
  • 59. What is the stated reason for the high mortality rate of HCC?
A) Diagnosis occurs at an advanced stage
B) Poor patient compliance
C) Lack of available treatment
D) Rapid resistance to chemotherapy
  • 60. Besides AFP, what other blood test marker is mentioned for the evaluation of HCC?
A) Liver transaminases
B) Alkaline phosphatase
C) Des-gamma carboxyprothrombin
D) C-reactive protein
  • 61. What is the AASLD's position on screening for cirrhosis secondary to fatty liver disease?
A) There is some controversy surrounding whether surveillance reduces mortality
B) It is standard of care worldwide
C) It is definitively proven to reduce mortality
D) It is not recommended under any circumstances
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