Complained of colicky abdominal pain radiating to the right shoulder and nausea for the past week. Vital signs normal. On examination, impression of tenderness with guarding; hard to tell if peritoneal irritation. CRP 41, liver function tests: AST 91 U/L, ALT 77 U/L, GGT 319 U/L, Alkaline phosphatase 149. History of hepatitis B virus (HBV). Currently not on any medication.

A triple-phase liver CT protocol was done, which showed innumerable small round masses scattered in a cirrhotic liver, suggestive of infiltrative HCC, possibly with regional lymph node spread. A CT chest was done (not shown here), which showed no metastatic spread to the chest.

A biopsy was obtained from a liver mass.
Histopathology:
Carcinoma probably of liver origin.
Immunostains:
Pankeratin, hepatocyte positive. CK19 negative. Glypican-3 inconclusive.