Hepatocellular carcinoma

Case contributed by Dr Hani Makky Al Salam

Presentation

Known case of thalassemia and hepatitis C infection

Patient Data

Age: 35 years
Gender: Male
x_ray

Diffuse bilateral ribs expansion.

Lateral paravertebral and rib masses in keeping with extramedullary hematopoiesis.

ultrasound

Hepatomegaly with a well-defined hypoechoic hypervascular hepatic lesion in segment 4 of the liver, with peri and intralesional vascularity.

ct

Classic findings in thalassemia of high attenuation hepatomegaly due to iron overload, splenectomy extramedullary hematopoiesis. In addition gallstones.

A segment 4 liver mass lesion with hyperenhancement on arterial phase and washout in delayed phase, suggestive of hepatocellular carcinoma.

12 months later

mri

Interval increase in the size of the hepatic lesion with interval development of new lesions. The lesion is currently invading the left portal branch forming a tumor thrombus.

Diffuse decreased T2 signal of hepatic parenchyma, in keeping with hepatic hemosiderosis.

12 months later

ct

Multiple bilateral lung nodules in keeping with diffuse lung metastasis. A metastatic lesion at T4 with intraspinous extension.

Interval increase in the size of the hepatic lesion with interval development of couple new lesions.

Case Discussion

Patient refuse any medical treatment and presented 1 year later with increasing abdominal girth in which MRI liver and CT scan chest demonstrate interval increase of the size of the probable HCC with multiple metastases to the chest and spine.

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