Hepatocellular carcinoma (exophytic)
Emergency department patient receiving a CT for unexplained abdominal pain. No history of cirrhosis or viral hepatitis. LFTs are within normal limits.
1 case question available
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There is a ~5 cm round, well-circumscribed mass extending exophytically off the inferior aspect of segment 5. It demonstrates mild arterial phase hypervascularity and mild hypoattenuation on the portal venous phase. Its enhancement is slightly heterogeneous. No evidence of a central scar.
The mass abuts the hepatic flexure of the colon, the gallbladder, and the ventral abdominal wall, without evidence of invasion.
There is no other lesion in the liver. The liver is otherwise normal appearing with no evidence of cirrhosis or portal hypertension. No portal vein thrombosis.
4 case questions available
This is a case of a well-differentiated exophytic hepatocellular carcinoma (HCC) in an elderly woman without cirrhosis or a history of chronic viral hepatitis.
The development of HCC in a liver without classic risk factors is uncommon, but even less common in Asia. The exact incidence of patients in North America and Western Europe who develop HCC without classic risk factors is not well-defined; a percentage have some history of a nonspecific liver injury (such as steatosis), but a percentage remain without any explanation for the development of the carcinoma.
HCC without risk factors is separate from fibrolamellar HCC, which is a different entity.
In a patient, such as the one above, in which a well-circumscribed hepatic mass appears in a patient without risk factors, a differential is appropriate, and biopsy or MRI would be a prudent next move. The mass above demonstrates possible washout, which is suspicious, and may make biopsy a more reasonable next step than MRI.