Multicenteric hepatocellular carcinoma in a cirrhotic liver

Case contributed by Dr Mohammad A. ElBeialy

Presentation

80 years old HCV positive patient with recently developed abdominal distension and markedly elevated alpha feto-protein.

Patient Data

Age: 80 years
Gender: Male
  • Liver cirrhosis with heterogenous parenchyma and undulating outline. A hepatic dome subcapsular 4.5 X 3.5 cm exophytic mass lesion is seen with rapid heterogenous arterial enhancement as well as progressive wash out & capsular enhancement  in the portal venous and delayed phases.
  • A relatively larger ill-defined segment VI heterogenously enhancing mass is seen with rapid portal venous and delayed wash out.
  • Innumerable small arterially enhancing lesions that get isodense in the portal-venous and delayed phases are seen.
  • No intrahepatic or extrahepatic biliary tree dilatation.
  • Portal hypertension, splenomegaly and marked ascites.
  • Enlaged right cardiophrenic lymph node is seen measuring 4 X 3 cm with mild arterial enhancement as well as portal-venous washout.
  • Small portahepatis lymphadenopathy.
  • Two left renal middle and upper calyceal stones are seen with mild upper calyceal hydronephrotic changes.
  • Normal right kidney (apart from a small upper polar 2 cm simple cortical cyst)  and pancreas.
  • Mild prostatomegaly.
  • normal urinary bladder and seminal vesicles.
  • Left oblique inguinal hernia and hydrocele.
  • Mild left pleural effusion.
  • Spondylodegenerative changes of the bony spine. No evidence of bony metastatic deposits.

Case Discussion

 

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Case Information

rID: 32775
Case created: 14th Dec 2014
Last edited: 16th Dec 2015
Inclusion in quiz mode: Included

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