AASLD recommends surveillance in individuals with cirrhosis who are at high risk of developing HCC A study conducted by experts at the Baylor College of Medicine found that less than 20 percent of patients with hepatocellular carcinoma preceded by cirrhosis were monitored for the advancement of cancer. Full findings of this study are published in the July problem of Hepatology, a journal of the American Association for the Study of Liver Illnesses . According to the National Cancers Institute, HCC is the fourth most common tumor in the global globe. In the U.S., 22,620 new situations of HCC had been diagnosed and 18,160 deaths due to this disease occurred in ’09 2009.Our patient got no overt laboratory abnormalities in regards to to immune function or blood leukocytes. Combinations of medicines that hinder immune surveillance of the central nervous system might confer an increased risk, and the three earlier reports of PML after natalizumab therapy all involved patients who got undergone concurrent treatment with either interferon beta or additional immunosuppressive agents.9 Our patient’s history demonstrates PML may also develop because of natalizumab utilized as monotherapy. Second, there are no options for monitoring patients who are treated with natalizumab for the first detection of PML. Clinical vigilance for symptoms suggestive of PML, which to some extent overlap with those of multiple sclerosis, is required.