Quiz: A 45-year-old bus driver without known liver disease was admitted to the emergency ward in the context of abdominal pain

During diagnostic work-up, blood examination showed a bilirubin of 0.8mg/dL (14 µmol/L), ALT 45 U/L, AST 40 U/L, ALP 210 U/L, and ℽGT 217 U/L, normal INR, AFP 200 mg/dL. HBsAg and anti-HCV were negative. A CT scan disclosed a nodule of 5cm with segmental vascular invasion in the liver, fulfilling the radiological criteria of LIRADS 5. No signs of portal hypertension or decompensation were found.