Pretend you are a teacher preparing a quiz for the text I will provide. 
            Each quiz question should follow the format below. 
            Ensure that you carefully recheck the questions and answers for accuracy. 
            The output should be a ready-to-use list of dictionaries for the Python eval function:

            [

                    "question": "WRITE THE QUESTION HERE",
                    "options": ["A) OPTION_1", "B) OPTION_2", "C) OPTION_3", "D) OPTION_4"],
                    "answer": INDEX_OF_CORRECT_ANSWER_IN_OPTIONS_LIST,
                    "explanation": "EXPLAIN WHY THE ANSWER IS CORRECT"

            ]

            Text:
            inflammatory infiltrate, 
sinusoidal dilatation 
 Associated with OCPs 
usage 
men, glycogen storage 
disease 
OCPs, obesity, metabolic 
syndrome, 
low risk of hemorrhage 
and malignancy 
Higher risk of 
malignancy 
high risk of hemorrhage 
Highest risk of malignancy associated with I-HCA with beta-catenin activation (b-
IHCA) 
 
Malignant tumors of the liver 
• Liver cancer is a global health challenge, with an estimated incidence of >1 
million cases by 2025. 
• Liver cancer includes a heterogeneous group of malignant tumors with 
different histological features. 
• They have an unfavorable prognosis. 
34 
 
Hepatocellular carcinoma HCC (Hepatoma) 
• Epidemiology: Accounts for 90% of primary liver cancers  
• Infection by the hepatitis B virus (in Asia and sub-Saharan Africa) and hepatitis 
C virus (in Western countries) are the main risk factors for HCC development. 
• More common in middle/older aged males. 
Pathogenesis: 
• Chronic liver disease with or without cirrhosis is the most common cause. 
• HCC is associated with a mutation in the Beta-catenin gene and the TP53 gene. 
HCC risk factors: 
• Viral infection (HBV, HCV). 
• Aflatoxin exposure: produced by Aspergillus species: in grain, nuts, corn 
• Anabolic steroids use 
• Inherited disorders (Hemochromatosis, Wilson's disease) 
• Metabolic syndrome (obesity, Diabetes, NAFLD). 
• Premalignant precursor lesion (Hepatic adenoma, dysplastic nodules) 
Grossly 
• Unifocal large mass, multifocal, widely distributed nodules of variable size or 
diffusely infiltrative cancer. 
• Tumor is soft, yellow, with areas of hemorrhage and necrosis. 
Microscopically, 
• Tumor cells (malignant hepatocytes) resemble normal hepatocytes but show 
pleomorphism with prominent nucleoli, arranged in trabeculae resembling liver 
cell plates, solid pattern or in a pseudo glandular pattern. Bile pigments may be 
present in dilated bile canaliculi. 
• Vascular invasion PV, HV is the hallmark of aggressive HCC. 
Clinical features: abdominal pain, hepatomegaly, Ascites 
Serum tumor marker: Alpha-fetoprotein (AFP) in 60-70% of HCC cases 
Imaging (CT-MRI) 
35 
 
Biopsy: Biopsy is avoided in clear cases due to risk of tumor seeding. 
It spreads locally to the liver, through lymphatic to LN of porta hepatic, or via blood 
(to the lung most commonly) 
The large tumor has a poor prognosis, and the majority of patients die within two years 
of diagnosis. 
Cholangiocarcinoma 
• Are primary malignant biliary tumors arising from the epithelium of the bile 
ducts.  
• Most of these tumors are adenocarcinomas. 
• They are more prevalent in Asia. 
• They are more common in males. 
• Typically present in the seventh decade 
Risk factors: 
•Primary sclerosing cholangitis. 
•Choledochal cyst. 
•Viral hepatitis and cirrhosis. 
•Hepatolithiasis (intrahepatic gall stone) 
•Parasitic infection (Hepatobiliary flukes) particularly in Southeast Asia. 
•Others (toxin, Inflammatory bowel disease, cholangitis, diabetes, obesity, heavy alcohol.

            Quiz: