A 44 year old man complaints of abdominal distention and nausea since few months. USG of abdomen shows a growth on right lobe of the liver. Tumor marker study shows the evidence of primary hepatocellular carcinoma. All of the following tumor markers will be raised in this patient, EXCEPT:

**Core Concept**
In primary hepatocellular carcinoma (HCC), tumor markers are used to aid in diagnosis, prognosis, and monitoring of disease progression. These markers are substances produced by cancer cells or in response to cancer.

**Why the Correct Answer is Right**
The most commonly elevated tumor markers in HCC include alpha-fetoprotein (AFP), lens culinaris agglutinin-reactive glycoprotein (L3 fraction), and des-gamma-carboxy prothrombin (DCP). These markers are produced by the tumor cells themselves or by the host's immune response to the tumor. In this patient with HCC, it is expected that AFP would be elevated, as it is the most commonly used tumor marker for HCC.

**Why Each Wrong Option is Incorrect**
* **Option A:** This option is not provided, but typically, other tumor markers like CA 19-9, CEA, and CA 125 are not specific for HCC and can be elevated in various other cancers or conditions.
* **Option B:** This option is not provided, but in some cases, other tumor markers like hCG or inhibin can be elevated in HCC, although this is less common.
* **Option C:** This option is not provided, but typically, other tumor markers like PSA or NMP22 are not specific for HCC and can be elevated in various other cancers or conditions.

**Clinical Pearl / High-Yield Fact**
Keep in mind that while tumor markers are useful in diagnosing and monitoring HCC, they are not always elevated in this condition. A combination of clinical, imaging, and laboratory findings is necessary for an accurate diagnosis.

**Correct Answer:** A.

✓ Correct Answer: B. Alpha 2 macroglobulin