Metastatic hepatocellular carcinoma

Case contributed by Amr Farouk
Diagnosis certain


Patient with diagnosed hepatic mass and osseous deposits and recent onset of jaundice.

Patient Data

Age: 70 years
Gender: Male

The liver is enlarged showing multiple bi-lobar hepatic masses and nodules nearly
totally consuming the hepatic parenchyma. The largest mass in the left lobe is seen
at segment IV and II measuring 7.8x12.3 cm and the largest mass at the right lobe is
seen at segment V measuring 8.3x7.4 cm. They are seen eliciting intermediate
signal on T1 and T2 weighted images.

The hepatic masses are seen causing distal peripheral intra-hepatic biliary radicals dilatation and central hilar biliary outflow compromise as well due to complete obstruction of the confluence of main hepatic ducts.The common bile duct and pancreatic duct are not significantly dilated.

Calculous gallbladder.

Enlarged gastro-hepatic, porta hepatis and left para-aortic lymph nodes. Mild abdominal ascites with diffuse omental and peritoneal soft tissue thickening with soft tissue sheets formation.
In-homogeneous signal of the infra-hepatic portion of the IVC.

Moderate right pleural effusion with fissure extension and underlying pulmonary collapse and minimal left pleural effusion.

L1 vertebral structural collapse with right para-vertebral soft tissue component and the posterior vertebral body cortex sagging posteriorly and associated soft tissue component effacing the thecal sac and indenting the cord. L3 right pedicle and adjacent vertebral body osseous lesion with associated soft tissue component. Right lower costal and sternal body osseous lesion with associated soft tissue components larger at the sternal body.

Case Discussion

A pathologically proven case of hepatocellular carcinoma with peritoneal/omental metastases and osseous deposits.

A biopsy was obtained showing pieces of tumor tissue formed of large malignant epithelial cells with abundant eosinophilic cytoplasm arranged in trabeculae and adenoid patterns with foci of brownish bile like pigments. Marked tumoral necrosis is noted.

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