**Question:** A 24 year old patient presented with unexplained weight loss and fever. Routine examinations shows elevated liver function tests. USG shows a growth in the liver which is confirmed as fibrolamellar carcinoma of the liver. What is NOT true about fibrolamellar carcinoma of the liver?

A. It is a common liver cancer in developed countries.
B. It occurs in children and adolescents.
C. It is a slow-growing cancer with a good prognosis.
D. It is a rare cancer that accounts for a small proportion of liver cancers.

**Core Concept:** Fibrolamellar carcinoma of the liver is a rare, aggressive liver cancer that primarily affects adolescents and young adults. It is characterized by rapid growth, often presents with non-specific symptoms like weight loss, fever, and elevated liver function tests, and may lead to complications such as portal hypertension and liver failure.

**Why the Correct Answer is Right:** D. It is a rare cancer that accounts for a small proportion of liver cancers is correct because fibrolamellar carcinoma is a rare type of liver cancer, accounting for only a small percentage of liver cancer cases.

**Why Each Wrong Option is Incorrect:**

A. It is a common liver cancer in developed countries - This is incorrect as fibrolamellar carcinoma is not common but rather rare, affecting a specific age group.

B. It occurs in children and adolescents - While fibrolamellar carcinoma can affect children and adolescents, it is not exclusive to this age group. It can also occur in young adults and occasionally in adults.

C. It is a slow-growing cancer with a good prognosis - This statement is incorrect as fibrolamellar carcinoma is an aggressive cancer, not known for its slow growth or good prognosis. In fact, it carries a poor prognosis and is often diagnosed at an advanced stage.

**Clinical Pearl:** Fibrolamellar carcinoma is a high-grade, aggressive liver cancer that predominantly affects adolescents and young adults. Its clinical presentation includes non-specific symptoms like weight loss, fever, and elevated liver function tests. Due to its aggressive nature, fibrolamellar carcinoma often presents at an advanced stage, resulting in poor prognosis. Early diagnosis and timely intervention are essential for better outcomes.