In cases of diagnostic difficulty, molecular analysis again might serve as a loophole: Recent data suggest that CTNNB1-mutations without any signs of atypia are very early events in the malignant transformation of liver nodules, that need to be accomplished by a second hit, the telomerase reverse transcriptase (TERT) promoter mutation, to carry forward malignancy [38], thereby TERT promoter mutation takes on a gatekeeper role in the formation of HCC developed from HCA [39]. Here, TERT is linked to hepatocellular carcinoma.