HCC is the most common primary malignant liver tumor and the 5th most common malignancy worldwide. HCC is three times more common in men than in women and has a multifactorial etiology. Chronic liver inflammation and necrosis promote hepatocarcinogenesis in the context of hepatitis B and C infections, iron overload, aflatoxin exposure, and fatty liver disease. The vast majority of cases of hepatocellular carcinoma in the United States develop in the setting of cirrhosis, usually macronodular type. About 3% of patients with cirrhosis develop hepatocellular carcinoma annually. The involvement is usually more diffuse (as seen here) than the tumors occurring in non-cirrhotic livers.