LEP and obesity due to melanocortin 4 receptor deficiency: It is believed that obesity plays an important role in HCC development by generating a chronic general low-grade inflammatory response due to an increased level of leptin and a relatively decreased level of adiponectin in obese patients [1]. Increased lipid storage in the liver leads to lipotoxicity that interferes with cellular signaling mechanisms and regulation of gene transcription promoting gene transcription alterations, which may result in HCC [1].