**Question:** True regarding fibrolamellar carcinoma (FLC) of liver are all the following EXCEPT

A. Fibrolamellar carcinoma is a rare liver tumor;
B. It predominantly affects adults;
C. It is typically associated with hepatitis B virus infection;
D. It is highly aggressive and has a poor prognosis.

**Correct Answer:** D. Fibrolamellar carcinoma is highly aggressive and has a poor prognosis:

**Core Concept:**
Fibrolamellar carcinoma (FLC) is a rare liver tumor that primarily occurs in young adults, especially in those with a history of hepatitis B virus (HBV) infection. While FLC is known for its aggressive nature, the statement "FLC is highly aggressive and has a poor prognosis" is incorrect. In fact, the association of FLC with HBV infection is more relevant to its pathogenesis and epidemiology than to its prognosis.

**Why the Correct Answer is Right:**
FLC is characterized by its rapid growth and early spread to lymph nodes and distant organs, particularly the lungs. Despite its aggressive nature, the prognosis of FLC is generally better than that of other primary hepatic malignancies, such as cholangiocarcinoma and hepatocellular carcinoma. This is because FLC is often diagnosed at an earlier stage due to the association with HBV infection, allowing for potentially curative treatments like liver resection or transplantation.

**Why Each Wrong Option is Incorrect:**

A. Fibrolamellar carcinoma is a rare liver tumor: While this statement is partially correct, it is not specific enough to differentiate FLC from other primary liver tumors.

B. It predominantly affects adults: Although FLC occurs more frequently in young adults, it can also affect teenagers and rarely, children. This option is incorrect because it doesn't emphasize the unique association with HBV infection and the better prognosis compared to other liver malignancies.

C. It is typically associated with hepatitis B virus infection: This statement is accurate, highlighting the key epidemiological feature of FLC.

**Clinical Pearl:**
The association of FLC with HBV infection has important implications for clinicians. In cases of young adults presenting with a solitary liver tumor, a high index of suspicion for FLC is essential, especially in endemic regions with high HBV prevalence. Early diagnosis and intervention may lead to improved outcomes compared to other primary hepatic malignancies.