A 58-year-old man with cirrhosis undergoes imaging for hepatocellular carcinoma surveillance. The radiologist identifies a 2 cm nodule in the liver parenchyma. Which hepatic segment is the most common site for hepatocellular carcinoma development?

Explanation

## Most Common Site of HCC in Cirrhotic Liver **Key Point:** Segment VII (posterior superior segment of the right lobe) is the most frequent site for hepatocellular carcinoma development in cirrhotic livers, followed by segments VIII and V. ### Why Segment VII? 1. **Hemodynamic factors**: Segment VII receives blood primarily from the right hepatic artery and portal vein branches, creating a zone of relative stasis and hypoxia in advanced cirrhosis. 2. **Cirrhotic nodule distribution**: In cirrhosis, regenerative nodules and dysplastic nodules preferentially develop in the posterior segments of the right lobe. 3. **Portal flow dynamics**: The posterior right lobe has slower portal venous flow compared to the left lobe and anterior right segments, predisposing to HCC transformation. ### Hepatic Segment Distribution in HCC | Segment | Frequency | Location | |---------|-----------|----------| | VII | Most common (25–30%) | Posterior superior, right lobe | | VIII | Second most common (20–25%) | Anterior superior, right lobe | | V | Third common (15–20%) | Anterior inferior, right lobe | | II–IV | Less common (20–25%) | Left lobe | **Clinical Pearl:** The right lobe (segments V–VIII) accounts for ~75% of HCC cases in cirrhosis, with the posterior segments (VII, VI) being particularly vulnerable due to portal flow stasis. **High-Yield:** On surveillance imaging (ultrasound, CT, MRI) in a cirrhotic patient, a nodule in segment VII warrants aggressive investigation and early intervention, as this is the highest-risk zone. **Mnemonic:** **"Right Posterior = HCC Risk"** — Remember that the right lobe posterior segments (VII, VI) are the cirrhotic liver's "danger zone" for malignant transformation.