“…Patients with underlying cirrhosis can manifest with signs and symptoms of decompensated end-stage liver disease and portal hypertension, such as ascites, splenomegaly, variceal bleeding, spider nevi, digital clubbing, and encephalopathy. Of note, up to one-third of pediatric HCC cases are detected incidentally, and patients are asymptomatic [ 123 , 126 , 127 ]. Fibrolamellar HCC (FL-HCC) typically arises in patients who do not have underlying liver disease or cirrhosis at the time of tumor development, and patients are classically younger with fewer comorbities [ 128 , 129 ].…”