Neoplasia USMLE Step 1 Practice Question
A 68-year-old man with a 20-year history of hepatitis C and known cirrhosis presents with right upper quadrant pain and early satiety. Vital signs are stable. Ultrasound reveals a 3.5 cm nodule in the right hepatic lobe with arterial-phase enhancement on contrast-enhanced CT. Serum alpha-fetoprotein (AFP) is elevated at 480 ng/mL. The patient meets imaging criteria for hepatocellular carcinoma (HCC). A biopsy shows microscopic vascular invasion. Which of the following molecular alterations best explains the aggressive phenotype with vascular invasion observed in this patient's tumor?
Answer choices
- AIncreased HIF-1α stabilization and VEGF upregulation promoting tumor angiogenesis
- BLoss of E-cadherin expression and activation of Wnt/β-catenin signaling driving epithelial-mesenchymal transitionCorrect answer
- CTP53 mutations leading to loss of apoptotic capacity and genomic instability
- DMYC amplification causing increased proliferative rate and reduced differentiation
- EEGFR overexpression through integration of hepatitis C viral oncoproteins
- FActivation of JAK-STAT signaling by constitutive IL-6 production
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