In the context of a large, aggressive hepatocellular tumor with highserum AFP levels, a newer entity should be born in mind: hepatocellularmalignant neoplasm, not otherwise specified (HCN-NOS) is a subset oftumors described at the 2014 COG liver tumors symposium.15 The discussion surrounding this consensus classification is explored furtherin the text, however an awareness of the spectrum of differential diagnoses is vitalbefore slide review. The gene discussed is AFP; the disease is neoplasm.