Hepatocellular carcinoma (HCC) in a cirrhotic liver with hypervascular "satellite" nodules and malignant portal vein tumor thromus

Case contributed by Dr Azza Elgendy

Presentation

14 years history of hepatitis C virus.

Patient Data

Age: 14 years
Gender: Male
  • The liver shows established liver cirrhosis, extensive nodularity and parenchymal dysmorphism. Large ill defined infiltrative mass involving the caudate lobe with tumor thrombus extending into the left branch of the petal vein as well as the main portal vein. Early arterial enhancement and wash out is seen consistent with frank HCC. Multiple smaller subcentimetric hypervascular lesions are seen elsewhere in the liver that could be dysplastic nodules rather than multicentric HCC.
  • Portal hypertension with splenomegaly, opened porto-systemic collaterals & ascites. 
  • Incidentally noted is a small gall bladder stone. 

Case Discussion

Established cirrhotic changes are seen. Ill defined infilterative mass involving the caudate lobe with tumor thrombus involving the left branch of portal vein as well as the main portal vein. Satellites are seen elsewhere suggestive of regenerative or dysplastic nodules rather than small multicentric HCC with tumor thrombus. Portal hypertension, splenomegaly and small amount of ascites.

The differential diagnosis of small hypervascular liver lesions in a cirrhotic liver is including arterioportal shunts or pseudolesions (for very small lesions), dysplastic nodules, and small HCCs. Occasionally,  a cirrhotic liver may have preexisting flash-filling hemangiomas that may mimic malignant lesions.    

Multiphasic magnetic resonance imaging (MRI) including DWI is extremely useful in the detection and characterization of regenerating and dysplastc nodules and small HCCs. 

 

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Case information

rID: 35108
Case created: 22nd Mar 2015
Last edited: 16th Aug 2016
Inclusion in quiz mode: Included

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